Baby Basics: How to get your baby to sleep through the night

sleep training cartoon get baby to sleep through the nightContinuing our series on the essentials of life…

If you have a newborn, stop reading and go back to feeding. It’s too early for your baby to sleep through the night. All babies lose a little weight in the first couple days of life, but then they are expected to gain. In fact, you may find that you need to awaken your baby to eat every couple of hours to eat in order to stabilize her weight loss. (see our prior post on breast feeding your newborn and our formula feeding post). While you feed your newborn, listen here to understand newborn sleep patterns:

Click here for our podcast – Sleep During the First Six Months

So, when to expect your baby to sleep longer at night? Usually after three months, your baby naturally takes more milk at each feeding and thus lasts longer between feedings. And once your baby is at least six months old, your baby may be able to sleep through the night. Set reasonable expectations. For some babies, sleeping through the night means six hours, for others ten.

At six months, object permanence fully emerges. Your baby will understand that you are somewhere even when you are not within sight. This is why he laughs hysterically when you play peek-a-boo with him. If he is dependent on you rocking him or feeding him to fall asleep, then he will look for you every time he awakens for help falling back to sleep. Also, don’t be fooled into thinking that because your baby nurses or drinks from a bottle at every night time wakening, he must be hungry. Usually he’s just looking for a way to fall back to sleep.

Training starts with making sure your baby knows how to fall asleep on his own. Make sure he can fall asleep on his own at the beginning of the night. Then train for the middle of the night. Above all, make sure you and your partner are on board with the same training strategy.  Keep bedtime roughly the same time every night, and start the bedtime routine before your baby is crying from exhaustion so he can enjoy this time with you. A typical bedtime routine for an older infant is bath (if it is a bath night), formula/breastfeed, wipe gums/brush teeth, read book, lullaby, kiss, and then bed. The exact order and events do not matter much, just finish the routine BEFORE your baby falls asleep. Lay him down on his back awake so that he has an opportunity to fall asleep on his own.

Don’t be frustrated if you try to sleep train for a few days and give up. There is no such thing as “missing” a golden window of opportunity to sleep train. If it’s not working out this week, try again next week.

Ultimately, use these principles behind a soothing, consistent bedtime and bedtime routine all the way through high school!

Sweet dreams.

Click here for our podcast- Sleep from 6mo to toddler

Naline Lai, MD and Julie Kardos, MD
©2014 Two Peds in a Pod®




Helping Your Baby to Sleep Through the Night

Are you exhausted because your baby wakes up at night?  Tune in to our podcast to find out how to teach your baby to sleep through the night.




Four month sleep regression

Tired parents, four month sleep regression“I think we just hit the four month sleep regression. My baby used to sleep better, and now at four months, she is waking up every hour! What happened?”

Sound familiar?

The term “four month sleep regression” did not appear on Google searches in the United States until 2006 and has been on the rise ever since.
It is not clear how the term came about. After all, babies existed well before 2006. Oddly, most of the search requests come from the state of California. Unfortunately, the term sleep regression has put many a parent into a panic. Do not worry. Sleep is not a developmental milestone, you do not need to move from California, and your baby is not regressing. Rather, your baby is changing. Just like eating and poop patterns change, sleep patterns also change.

Sleep in the beginning

In the beginning… there is newborn sleep. Newborns can fall asleep anywhere at any time: while feeding, in a stroller, on your chest, in your arms, in the car or on the floor. Sometimes they sleep for minutes, sometimes they sleep for a few hours.

For the first three months, babies are in a feeding frenzy mode. Babies this age gain about one ounce per day (a huge feat) so therefore they eat to sustain growth. So they eat, and eat, at a pace of every one and one-half to three hours. They are hungry but their bellies are small, so they must eat frequently. Sometimes they cluster feed every hour. Because they spend so much time feeding, chances are they often fall asleep while sucking either a breast or a bottle. Some babies, by the end of the third month, are sleeping longer at night and making up for missed feedings during the day.

The plot thickens…

Between three and four months, babies slow in the pace of their growth. From three to six months they gain only about one-half an ounce per day. Because they are not quite so ravenous and because their bellies are bigger now, they can wait longer between feedings. You will notice that a more discernible pattern to their day emerges and you can now tell the difference between “hungry” and “tired” cries.

Another change occurs around four months. You will notice that when your baby is hungry, they get excited when they either hear or see you preparing a bottle or positioning to breastfeed. They become AWARE that a feeding is about to happen and recognize events that immediately precede a meal.

That same awareness occurs around sleep. When she feels sleepy, your baby becomes aware of events that lead up to sleep. If that event is eating, then she will believe that EATING precedes SLEEPING. If that event is rocking with a parent to sleep or laying in a parent’s arms, then they learn that rocking or being held is the key to falling asleep.

The final piece of the puzzle

This increased awareness of sleep associations is likely the origin of the four month sleep regression. You see that the 4 month sleep regression actually is not a regression, but rather an AWARENESS of how to fall asleep. If you always put your baby down in the crib when tired, they will learn that resting in a crib is how to fall asleep. If you play music and put the baby in the crib, the baby will expect music and a crib to fall asleep. And if you always feed your baby to sleep, then feeding becomes the key to falling asleep.

Unlike when they were newborns, if you always put your four-month-old baby in the crib AFTER they fall asleep, they will eventually sense that something is different, and they will wake up. Imagine if you fall asleep in your bed and then wake up to find yourself on the front lawn. You will think to yourself, “WHAT ON EARTH JUST HAPPENED?” Then you will stomp back into the house and find your bed in order to go back to sleep.

If your baby falls asleep breastfeeding, and then you put them down in a crib, your baby may realize that the breast is no longer there. The realization will jolt them out of sleep (WHAT ON EARTH JUST HAPPENED?) and they will cry until you comply with your baby’s demand to breastfeed in order to fall back asleep. All understandable.

The solution: how to overcome the four month sleep regression

Herein lies the key to overcoming the four month sleep regression. Teach your baby that she wants to be in the CRIB to fall asleep. Now is the time to change up the bedtime routine so it ends with your baby in the crib AWAKE and then your baby will fall asleep on her own in the crib. Then, if she wakes up later in the night, she will think to herself: “Ok, I am in the crib, just where I was before. I am still tired and will go back to sleep now.” Same at nap time. When your baby gets drowsy, put her in her crib. It is not necessary to feed her first.

We do not advocate letting your baby “cry it out” yet— four months is too young. Developmentally, a four-month-old does not understand cause and effect. Anytime you show up, it’s a happy surprise. They do not realize that they have the power to “make you come.” However, you can allow for a bit of crying (say, five minutes maximum) because some babies need to unwind before they fall asleep. Remember, if you last fed your four-month-old within the hour, they are not hungry. They are just fussy. Do you remember stomping your foot as a child, rubbing your eyes and crying to your parents, “I am not tired! I do not want to go to bed now.”

If, however, your baby is not showing signs of self-soothing after a couple minutes, then go to them and pat them gently or pick them up for a cuddle. But, as soon as they calm down, put them back into the crib so they can learn to fall asleep in the crib, not on you. Allow them to learn that their crib is coming when they are tired, just as they learn that a breast or bottle is coming when they are hungry.

Once babies learn to fall asleep in the crib, many night time awakenings just stop happening. Keep in mind, most four-month-olds do not sleep for eight hour stretches overnight. Many still wake up once or twice to feed. Keep the feedings brief, and put your baby back into the crib BEFORE they drift off to sleep. Also, many babies are ready for additional solid food at this point. Discuss with your pediatrician if it’s time to give solid sustenance during the day along with liquids.

A parenting truth

The bottom line? The four month sleep regression is not a regression. Rather, it’s a sign of your baby’s emerging awareness of her environment and her readiness to learn how to fall asleep.

Julie Kardos, MD and Naline Lai, MD
©2019 Two Peds in a Pod®




Can’t fall asleep? Relaxation techniques to quell anxiety

relaxation techniques

I love kids who worry. If they didn’t worry, they wouldn’t care, and if they didn’t care, nothing would ever get done. But sometimes, those worries grow bigger than your child and threaten to engulf them. Like any skill, you can teach your child to calm their mind and settle their emotions. Helping them with relaxation techniques as they fall asleep will translate into the ability for your child to calm themselves during the day.

When your child was a baby you would rock them, sing to them, and maybe give a pacifier. But now that they are older, other calming modalities are available.

Start with yourself. Your child looks to you to see how to act. If you constantly feel off balance yourself, you will find it difficult to convey reassurance and confidence. Therapist Dina Ricciardi reminds parents to incorporate mindfulness into our daily lives. She says, “Relaxation techniques should tap into one or more of our five senses. Tactile – doing something with our hands such as knitting, gardening or baking, or sitting in a warm bath; auditory – such as listening to music or nature sounds; olfactory – aromatherapy oils and diffusers, visual – looking at photos or art, a crackling fire, or visualizing a face or place that makes you happy; taste – sipping a cup of tea.” One app for meditation and mindfulness is found at headspace.com. For kids, Ricciardi suggests Mind Yeti. “Anxiety is easily projected, parents need to understand they are barometers,” says therapist and resilience expert Amy O’Neil.

Events in the day can affect your child’s ability to clear their head at bedtime. Generally, anything that disrupts routine is difficult for kids. Change, even good change, can cause stress. Also, don’t assume that your greatest concern is necessarily your kid’s greatest concern. You may be worried about mass shootings and your child might be worried that you will find out that they failed a math test that day. Understand where your child is developmentally—trying to explain negative news events and holding long discussions about future repercussions may only confuse your child if they are not developmentally ready to comprehend the news. This post gives you ideas of how to present tragic events to your kids.

Check to make sure that your children’s bedtime routine is conducive to sleep and feels secure and cozy at all ages. Instill healthy sleep habits and don’t rev up their minds just prior to sleep. Close to the targeted bedtime, avoid screen time and homework. Create a bedtime routine which includes a tuck in by you at any age. Convey that you are putting them in a safe place and that it’s okay to “let go.” For relaxation, as part of the bedtime routine, you can guide your child through deep, diaphragmatic breathing or a guided imagery exercise. Click here for more details from Dr. Sandy Barbos.  Ricciardi is also a fan of the 4×4 breathing relaxation technique used by Navy Seals. In this technique, one inhales for four seconds, holds for 4 seconds, then exhales for 4 seconds. This pattern is repeated.

After guiding your child, allow them time to self-calm by themselves immediately before bed. This time, which some call meditation or prayer, becomes your child’s self-calming quiet time and allows them to drift off to sleep on their own.

Giving your child the ability to relax and fall asleep on their own, no matter what swirls around them, is a gift they will cherish into adulthood.

Naline Lai, MD and Julie Kardos, MD

©2018 Two Peds in a Pod®




How to help your baby/toddler/school-aged child/teen sleep

baby child sleepWhen I was a child, a special treat was to have a sleepover at my grandparents’ house. My grandfather was an early riser and to this day I can still hear him roaring “When Pop-Pop’s up, EVERYBODY’S UP!” as I awoke to the aroma of my grandmother’s hot breakfast.

As all parents know, when BABY’s up, EVERYBODY’s up. What‘s the secret to good sleep? It’s all in the bedtime routine.

Parents should establish a good bedtime routine when their children are babies and should continue to enforce the routine until their children grow up and leave home. Just as prevention of heart disease begins with establishing healthy eating and exercise habits when your children are young, prevention of adult insomnia starts with establishing a healthy bedtime routine.

Here are ways to help your kids sleep from infancy through young adulthood: Start with our most commented upon podcast: how to help your baby to sleep through the night. Parents of preschool-aged kids will appreciate“sleep invaders”: nightmares, night terrors, and other monsters under the bed.  Even if you don’t have a teen, read our post on the Tired Teen.

Now that winter break is a memory, it’s time to buckle down and rid your child of the jet lag that persists from the “vacation sleep schedule.” For more ways to do this, refer to “Get your child back on a school sleep schedule.”

May you have a good night this and every night!

Julie Kardos, MD and Naline Lai, MD
©2014 Two Peds in a Pod®




Baby sleep positioners kill

back tp sleep

Because we couldn’t have said it better ourselves, today we share pediatrician blogger Dr. Roy Benaroch’s post from his pediatric blog, The Pediatric Insider.  In practice near Atlanta, Georgia, Dr. Benaroch is an assistant clinical professor of pediatrics at Emory University, a father of three, and the author of  The Guide to Getting the Best Health Care for your Child and Solving Health and Behavioral Problems from Birth through Preschool. –Drs. Kardos and Lai

The AAP has been warning against these things for years, and finally the FDA and CPSC have weighed in: Infant sleep positioners don’t prevent SIDS, and don’t save lives. But they can kill your baby.

These things are wedge-shaped or U-shaped gizmos that are supposed to keep your baby in a certain position while sleeping, supposedly to prevent SIDS and other alleged problems. But the “back to sleep” anti-SIDS campaign, which has reduced deaths by over 50%, never suggested to have to keep your baby on his back. The message from the back to sleep campaign has always been to put your baby down on his or her back, then to go away. Once your baby can move or roll to a different position, that’s fine.

The SIDS prevention guidelines are pretty straightforward, but that hasn’t stopped companies from capitalizing on fear to sell devices that they claim will reduce SIDS. Special monitors, mattresses, pillows, bumpers, and infant positioners have all claimed to protect babies, yet the FDA (nor the AAP, nor anyone else who knows what they’re talking about) has ever endorsed or approved any such device.

Want to prevent Sudden Infant Death Syndrome? Here are some proven methods. These are from the AAP’s Details and references are all in the AAP’s 2011 policy statement on preventing SIDS and other sleep-related infant deaths, which includes more details and references for all of these recommendations.

  • Breastfeed.
  • Immunize – follow the established schedule, which reduces SIDS by about 50%.
  • ALWAYS put your baby down to sleep on his or her back.
  • Don’t use bumper pads or other padded fluffy things in the crib.
  • Always use a firm, flat sleep surface. Babies should not routinely sleep in carriers, car seats, or bouncy seats.
  • Place your baby on a separate sleeping surface, not your bed (Bed sharing is discouraged.) Babies can sleep in their parents’ room, but should not sleep in their parent’s bed.
  • Wedges and sleep positioners should never be used.
  • Don’t smoke during or after pregnancy.
  • Offer a pacifier at sleep and naptimes.
  • Avoid covering baby’s head.
  • Avoid overheating.
  • Practice supervised, awake tummy time to help motor development and avoid flattened heads.
  • Ensure that pregnant women and babies receive good regular care.

The AAP’s recommendations not only address specific, known, modifiable risk factors for SIDS, but also help reduce the risk of death from suffocation and other causes. They are the best way to help keep your baby safe. Forget the hype and expense and unfounded promises from manufacturers—you can best keep your baby safe without buying anything.

© 2012 Roy Benaroch, MD
Reprinted with permission in Two Peds in a Pod®




It’s National Sleep Awareness Week: nothing to snooze at

 

Wake up!

 

Remember that sleeping, along with eating, peeing and pooping, is an essential of life that helps your child (and you) function well. Inadequate sleep is associated with obesity, learning difficulties, behavior problems, and emotional lability (gotta love the whining of an overtired kid.)

In honor of the National Sleep Foundation’s National Sleep Awareness Week, which ends on March 11when Americans “spring ahead” the clocks and we ironically lose one hour of sleep, please refer to our earlier podcasts and blog posts on sleep. We invite you to learn about how to teach healthy sleep habits to your kids and yourselves (the parents). 

The podcasts:
Sleep Patterns of the Newborn
Helping your baby to sleep through the night
-“There’s a monster under my bed”: all about nightmares, night terrors, night wandering, and bedwetting
The tired teen

The blog posts:
-Sleep Safety: How to decrease your baby’s risk of Sudden Infant Death Syndrome (SIDS)

-Parents of newborns: get your Zzzzzs back
I Need a Nap!
Wake up, sleepy-head, it’s time for school!

When your child’s bedtime seems too late, or, will I ever get a late night alone with my spouse again?

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®




Holy Cannoli, Two Peds in a Pod® turns ten!

 

Two Peds in a Pod® turns 10 years old

This little ten-month-old wishes Two Peds in a Pod® a happy ten-YEAR-old birthday!

Let’s take a stroll back ten years to 2009. Ten years ago Facebook was just five years old. Back then there was no Instagram (2010), no Pinterest (2010), no Snapchat (2011).  People were mesmerized by virtual vegetable picking (FarmVille) and taking care of Zhu Zhu pets. Bulky video gaming consoles ruled. The “New” Super Mario Bros. Wii really was “new.” Apple’s “pile of poo” emoji had just arrived the year before. And ten years ago, Two Peds in a Pod® was born. The idea that doctors would write advice on the internet was so novel that even NPR thought the concept worthy of a story. Today we take a Happy Birthday look back at our first five posts:

Then and now

Our blog’s first five posts, from the summer of 2009, include the very same topics parents ask us about now in the summer of 2019. 

Back then parents wondered about infant sleep, or lack thereof. Please note that we began our infant sleep podcast with the reminder that newborns are not meant to sleep through the night. Fisher Price should have listened to our podcast, because now in 2019 we are writing about rock‘ n play recalls

Two posts tackled  Potty training and picky eating. Spoiler to both posts: you can lead a horse to water but you can’t make him drink!These days, we’re still talking about both topics in the office. But now, people also ask about the need for probiotics to regulate bowels and digestive health in their child. Unfortunately, in 2019 probiotics have not panned out to be the hoped-for panacea for all gastrointestinal ailments. But they are helpful in some types of diarrhea

In 2019 we talked about the tick borne illness Lyme disease and we’re still talking about ticks now. As for the  mystery object Dr. Lai found in a drawer, ten years later the models are kinder and sport a raised lip instead of a contraption that can break off. 

Blog writing a decade later

Internet traffic has grown exponentially. Possibly because of so many sources of misinformation, we see more and anxious parents who receive conflicting information about how to raise their kids. We depend on you to let your friends know about this site. We would rather spend more time on writing than on search engine optimization. Despite the congested writing climate, our mission (read our maiden voyage) remains the same, to bring you practical pediatric advice. What fuels us? Our intense and comprehensive pediatric training from Children’s Hospital of Philadelphia, our combined over forty years of practicing pediatrics, and our passion for helping children and their families, give us the experience and the motivation to continue to help all of you whether online or in our offices.

A last blast from the past

How many of you remember our initial logo penned by the combined efforts of Dr. Kardos’s brother and her sister-in-law? That’s an iPod dangling from Dr. Lai’s neck-remember those?

two peds in a pod original icon

It’s good to be ten.

Julie Kardos, MD and Naline Lai, MD
©2019 Two Peds in a Pod®

 




What do Rock ‘n Play and socks have in common? They’ve both been recalled this year. Predicting what’s up next:

child product recall

Whenever we look at the child product recall lists from The Consumer Protection Safety Commission (CPSC), it never fails to amaze us that even big brand names crop up in product recalls for children. Ironically, most are not new-fangled products. Bouncer seats, high chairs, rattles, and bicycle helmets are often amongst the recalls. We figure after decades of baby product manufacturing, designers and production managers would understand what constitutes a potential hazard for kids.

We urge you to scrutinize the kid merchandise in your house and identify the potential hazards before your child ends up as the reason a product is on the CPSC list. In fact, you might have already missed a recall on your older products. According to kidsindanger.org, child product recalls occur a couple of times a week, but when a baby product is recalled, only 10-30 percent are ever retrieved. Because recalls occur AFTER injury or death occurs, it is better if parents assess the safety of child products before a recall.

Here are some common reasons for recalls:

Products fail to adhere to the American Academy of Pediatrics safe sleep guidelines. We know parents of crying young infants are often desperate to get some sleep themselves, but many sleep products are not studied. If it seems too good to be true, it probably isn’t. Infants are not ready developmentally to sleep through the night, so any product that promises to help your infant sleep through the night is, by definition, problematic. An example is the Rock ‘n Play sleeper which was recently recalled. The soft squishy inclined cradles clearly did not adhere to the safe sleep guidelines, but often we heard a parent say, ”But that’s the only place they will sleep.” Unfortunately, this recall does not undo the deaths of the 32 reported babies who died in the sleeper. In the wake of the recall, other companies who make similar sleepers are also recalling their products.

We cringe every time a family tells us they are using a new fangled piece of wrap-around-baby sleep gear or sleeping contraption, because
most involve soft surfaces (not advised), inclined surfaces (not advised) or things-in-the-crib-other-than-your-baby (also not advised).

Choking hazards: Babies and toddlers explore the world by mouthing objects. So drop on your hands and knees and see the world from their perspective. And don’t assume your kid has reached an age when “they should know better.” Ever wonder why many Monopoly game pieces go missing? Or why so many kids visit Emergency Departments after swallowing coins? In the past twenty years, the number of children visiting U.S. emergency rooms for swallowing objects doubled. Anything that can fit into a toilet paper tube (2.5 inches in diameter) is considered a choking hazard. Be aware that the toy may be too large to choke on, but a piece that breaks off may be small enough to choke on. Some great example of poorly thought-out products are teething necklaces made of beads strung together and decorative buttons on baby socks.

Ingestion hazards:

  • Magnets might be a fun toy, yet they can stick together after a kid swallows them and erode through any piece of gut trapped between them. In fact, even when a parent is fairly certain that their child ate only one single magnet, we pediatricians know that because magnets can be so dangerous, we will check an X-ray, just in case there are more. After all, even an older kid is sometimes too embarrassed to fess up on the number swallowed.
  • Batteries can corrode through the lining of the intestines, constituting an emergency. Check to make sure all battery backings are secure. Particularly problematic are button batteries. They are tiny and easily swallowed.
  • Brightly painted wooden toys are beautiful, but they may contain lead paint. So can kid jewelry. Lead poisoning occurs usually through eating or drinking contaminated objects such as lead containing paint or paint chips. Be aware of old toys (think antique doll houses) made prior to 1978 (when lead was taken out of paint in the US), toys manufactured in China or other Pacific Rim countries, or imported candies from Mexico. If you are wondering about possible lead exposure, ask your child’s doctor to test your child for lead exposure with a simple blood test. Avoid purchasing home lead kits because they can be inaccurate.

Head entrapment hazards: Infant heads and toddler heads can get wedged. Be aware that slates on a crib need to be no more than 2 ⅜ inches apart, or no bigger than the diameter of a soda can. Beware of baby carriers or high chairs that could allow babies to slip through.

Fall hazard: Check to see all buckles are secure and unlikely to catapult your child out of the restraint. Baby carriers and strollers, especially the jogging ones, seem to crop up often in recalls.

For general guidelines for baby proofing click here.

Sign up for child product recall alerts through the CPSC, the American Academy of Pediatrics,  or kidsindanger.org. Help other families by reporting product concerns to CPSC.

Dr. Lai tells this tale: Years ago, my first child’s crib came with plastic clips which held up her mattress. As my husband and I assembled the crib, a few of the clips snapped and broke. By my second child, even more clips broke apart. By my third child, the crib clips were recalled.

Perhaps we should have been suspicious the first time.

Naline Lai, MD and Julie Kardos, MD
©2019 Two Peds in a Pod®




Breast feeding and returning to work

breast feeding and returning to workPicture this: you are going back to work after a too-short maternity leave. Briefcase? Check. Lunch? Check. Breast pump? Check. Photo of your baby to put on your pump for inspiration? Check.

Many moms ask how to continue breastfeeding when they return to work.  Because babies should receive breast milk or formula for at least their first year, here is how you can incorporate breastfeeding into your work routine:

Offer bottles by four weeks of age. Bottles can contain breast milk or formula, but you need to give your baby practice taking milk from a bottle by four weeks old. If you wait much longer, your baby will likely refuse the bottle. Have someone other than yourself give at least one bottle per day or every other day. In this way, your baby learns to accept nutrition from someone else.

Store breast milk using the simple and conservative “rule of twos.” Leave breast milk in a bottle at room temperature for no more than two hours, store breast milk in the refrigerator for no more than two days, and store in the freezer for no more than two months. If your baby has already sucked out of a breast milk bottle, that milk is only good for up to two hours. Remember to write the date on your milk storage bags and use the oldest ones first.

Now select from the following breast feeding menu, understanding that you might start with an earlier option and then change to a later one. The best option is the one that works best for you and your baby.

Option 1: Continue to breast feed at work. This option works for moms who work from home, moms who have child care in their work setting, and moms close enough to dash home to breast feed during the day or who have caregivers willing to drive babies over to work for feedings.

Advantage: no pumping, no buying formula, no bottle washing. Disadvantage: may require some creative scheduling.

Option 2: Breast feed when home and pump and store breast milk at work. The baby gets breast milk in bottles during the work day. This method allows moms to provide exclusively breast milk to their babies. Start pumping after the first morning feeding (or any other feeding that you feel you produce a bit more than your baby needs for that particular feeding) beginning when your baby is around four weeks old. Also pump if your baby happens to sleep through a feeding. Store this milk in two or three ounce amounts in your freezer. You can obtain breast milk freezer bags from lactation consultants and baby stores, or you can store milk in zip lock bags. As you continue to pump after the same feeding each day, your body will produce more milk at that feeding.

Pumping should not take longer than 15 minutes if you’re pumping both breasts at the same time and can take as short as 7-10 minutes. Remember to wash your hands before pumping.

What kind of breast pump should you buy/rent? If you are in it for the long haul, we recommend the higher-end electric double pumps with adjustable suction. Ask the hospital nurses, your midwife, or your obstetrician for names of people who rent or sell pumps in your area.

Once you have some breast milk stored and you are a few days out from returning to work, try pumping during the feedings you will miss while at work. Have someone else feed your baby breast milk bottles for these feedings. Finally, when you return to work, continue to pump at the same schedule and leave the stored breast milk for your child’s caregivers. Consider leaving some formula in case caregivers run out of breast milk. Remind them never to microwave the milk (this kills the antibodies in breast milk as well as creates a potential burn hazard) but rather to thaw the milk by placing in a hot water bath.

This method becomes easier as babies get older. Once babies start solid foods, they breast feed fewer times per day. Somewhere between six to nine months, your baby eats three solid food meals per day and breastfeeds four or five times per 24 hours. Thus, the number of times you need to pump decreases dramatically.

Advantage to this option: breast milk with its germ-fighting antibodies given through the first year and no expense of formula. Disadvantage: having to pump at work.

Option 3: Breast feed before and after work and give your baby formula while you are at work. If you do not pump while at work, your body will not produce milk at these times. If you work full time, then on weekends you might find it easiest on your body to continue your “work time” feeding schedule. If you choose this method, wean your baby from daytime breast feeding over that last week or so before returning to work. Suddenly going a long time without draining your breasts can lead to engorgement, subsequent plugged ducts, and mastitis.

Advantage: baby continues to receive breast milk. No need to pump at work. Disadvantage: you still have to wash bottles and have the added cost of formula.

Option 4: Breast feed until you return to work, then formula feed. Wean over the last week you are home with your baby to avoid engorgement and leaking while at work. Your baby still benefits from even a few weeks of breast milk.

Advantage: No need to incorporate pumping into your work schedule. Baby still gets adequate nutrition. Disadvantage: babies who are in childcare and exposed to many germs miss out on receiving extra antibodies in breast milk. However, weaning your baby off breast milk will not cause illness. Do what works for your family. Another disadvantage: more expensive to buy formula and time-consuming to wash bottles.

Finally, remember that the calorie count and nutritional content of breast milk and formula are the same. So do NOT feel guilty if pumping does not pan out and you and end up giving some formula. Your baby is almost always going to be more efficient than a breast pump and some breasts just don’t produce milk well during pumping sessions. In contrast, some of my patients never got the hang of breast feeding and their moms pumped breast milk and bottle fed them for the entire first year. Dr. Lai and I have each had patients who refused to take a bottle at childcare but just waited patiently for their moms to arrive. These babies got the nutrition they needed by nursing throughout the night. The babies didn’t mind what time of day they ate. Just like many aspects of parenting, sometimes with breast feeding and returning to work, you just have to “go with the flow.”

Julie Kardos, MD with Naline Lai, MD
2015 Two Peds in a Pod®, reposted from 2010