Ask The Lactation Consultant

by Jan Gambino Patient Expert

Breast milk is often the ultimate "comfort food" for a baby with gastro-esophageal reflux since breast milk is easy to digest and well tolerated by many babies. At the same time, a baby with reflux may have difficulty nursing due to pain and discomfort. A Lactation Consultant may provide much needed information and support to help a mother and baby work together. I asked Melissa Nagin, Lactation Consultant and expert on to discuss nursing a baby with reflux.

What does a Lactation Consultant do?

A Lactation Consultant is a health professional who offers breastfeeding assistance and education. They provide a variety of services such as individual consultations, prenatal breastfeeding classes, postpartum support groups and assistance with breastfeeding products such as breast pumps.

What type of training/certification does a Lactation Consultant have?

To call yourself a "lactation consultant" you must carry the designation "IBCLC" (International Board Certified Lactation Consultant). This means that you have completed eligibility requirements per the International Board of Lactation Consultant Examiners, which varies depending on your background. Some IBCLCs are health care professionals working in maternal-child health and some have had no clinical background whatsoever.

When should a mom call a Lactation Consultant?

Soon after giving birth, many new moms decide to see a lactation consultant to have a breastfeeding check-up and get answers to questions they might have. In part, they may also see a lactation consultant simply to set their minds at ease that everything is, in fact, going well. But, there are times when women seek the help of a lactation consultant because they have more serious issues.
You can call in a lactation consultant whenever you feel the need, even if it's just for support. But here are some indications that you need to see one:

  • The baby is feeding every hour.

  • Feedings last more than an hour.

  • The baby sleeps for more than 4 to 5 hours, 2 or more times in a 24-hour period.

  • The baby feeds fewer than 7 times in a 24-hour period.

  • The baby has fewer than 4 bowel movements in a 24-hour period.

  • You are have severe nipple pain

  • You have a tender, swollen area in your breast.

What are your best tips for getting started with breastfeeding?

Nurse as soon as possible, ideally within the first hour or two after delivery when the baby is often alert and ready to get started. Once you are home rest as much as possible. Your body has worked hard during labor and delivery and needs to rest and recover as much as possible.

What can a mom do if her baby is fussy, pulls away from the breast or arches her back during a feeding?

This is one of the most common concerns I get in my weekly support group. There are quite a few reasons a baby can be fussy, pulls away, or arches her back during a feeding. The most obvious is that the baby is uncomfortably gassy and needs to burp. Sometimes the baby is overtired and doesn't know what to do with herself...she might attempt to nurse, but then realizes she's not hungry and pulls off and can't settle down to actually fall asleep. Another reason is the baby is frustrated by flow, particularly if mom has a low milk supply or a very forceful let-down reflex (milk ejection reflex) and the amount of milk coming down overwhelms the baby, causing him to swallow an excessive amount of air. And of course if the baby is in pain from reflux, there will be fussing and pulling away.

Will certain foods affect the milk and cause fussiness or digestive problems for the baby?

The breastfeeding mother needs to eat about 500 extra calories a day. She should eat
anything and everything that she wants in addition to continuing her prenatal vitamins. So many myths and wives' tales circulate about what a nursing mother should not eat, and she should take care to ignore all of them. The most common? "Don't eat broccoli, garlic, onions, spicy food, citrus, or chocolate." The truth is that the most common sensitivity
breastfed babies have is to the protein in cow's milk. So if a mother observes abnormal fussiness or colic, it would be wise to take cow's milk products out of her diet. It takes about 10 to 14 days for the protein to be eliminated from the mother's system, so she shouldn't expect results immediately and should wait that period of time to see what happens. That said, if there is a family history of allergy to a particular food, she should avoid eating it so that it is not introduced to the baby. Some studies have shown that maternal dietary restrictions during breastfeeding seem to provide benefit against development of eczema, but keep in mind the above recommendations as far as eating enough calories and eating may be harmful to mom's health if the proper amount of nutrients are not obtained through diet.
What are your best tips for nursing a baby with Gastroesophageal Reflux?

For a baby with GERD, I always recommend:

  • Nursing in as best an upright position as possible. I've had babies who have learned to nurse sitting up and straddling mom's leg

  • If mom has a forceful let-down, I would recommend hand-expressing some milk for a few minutes prior to feeding the baby. This will relieve the breast of some foremilk, which can flow too quickly and the let-down will not be as overwhelming to the baby.

  • Nurse frequently and allow the baby to finish one breast entirely to ensure the balance of foremilk and hind milk.

  • Watch your caffeine intake! Too much caffeine in your diet can exacerbate reflux in your baby.

  • See a lactation consultant to assess the latch! If the baby isn't latched well, she may swallow too much air, which can contribute to the discomfort.

For more information contact:Melissa NaginGuide to Breastfeeding | Guidance. Not Guesswork.

Jan Gambino
Meet Our Writer
Jan Gambino

Jan wrote for HealthCentral as a patient expert for Acid Reflux.