Breastfeeding: A Foundation for Life

By Alana Salcido, registered nurse and lactation consultant at CHOC Children’s

If you were to ask me back in nursing school what kind of nurse I wanted to be, I guarantee I never would have said I wanted to become a lactation consultant. I honestly didn’t even know this was a specialty at that time. Helping other moms succeed with breastfeeding is my way of giving back and my way of changing the world, one couple at a time.

World Breastfeeding Week 2018

Today kicks off World Breastfeeding Week, an annual observance to bring awareness to the importance of human milk and to offer education and encouragement to mothers, health care providers, and the community.

Breast milk is constantly changing

A mother’s milk is constantly changing. Her milk will actually change from feeding to feeding, day to day, month to month as her baby grows. For example, the first milk, known as colostrum, is rich in components that prevent and protect the newborn from common and potentially serious infections. Breastfeeding not only provides exceptional nutrition but it also promotes lifelong health benefits.

Benefits of breastfeeding: preventing disease

Breastfeeding is the most economical solution to the biggest threat against children’s health worldwide: malnutrition and preventable diseases. In developing countries, human milk can mean the difference between life or death in children under five because a mother’s milk provides necessary nourishment for babies.

Breast milk-fed infants have significantly lower rates of illness—even in industrialized countries. The longer a mother breastfeeds, the more infection fighting antibodies are passed to her infant through her milk. Just as the womb protected and nourished the developing child during pregnancy, the body was preparing to protect and nourish her baby after birth by stimulating milk production as early as 12-14 weeks gestation.

Lifelong benefits of breastfeeding

Research has shown that babies who receive breast milk have a lower risk of hypertension, type 1 and type 2 diabetes, allergies, cancer, asthma, intestinal and respiratory infections, and obesity both during childhood and adulthood. Health benefits occur not only for the baby, but for the mother as well. Breastfeeding helps reduce the maternal risks of diseases such as hypertension, type II diabetes, high cholesterol, osteoporosis, breast cancer, and even Alzheimer’s Disease. Research has shown that the health benefits, for both mom and baby, are dose dependent. This means that the longer a woman breastfeeds the greater the health benefits she and her baby receive. Because of this, the WHO (World Health Organization) recommends breast milk in a child’s diet for the first two years of life (with the addition of appropriate complimentary solid foods beginning at 6 months of age).

Lactation consultants can help mothers provide the benefits of breastfeeding

Some mothers who wish to breastfeed their babies face challenges. Statistically, 75 percent of moms in the U.S. start out breastfeeding. By the time babies are six months old, only 44 percent are breastfed.

CHOC Children’s has a team of registered nurses who are international board-certified lactation consultants. We work closely with medical teams to provide support to mothers who need assistance in producing lifesaving breast milk for children. We can also help them achieve their lactation goals which may be different for each mother and could include pumping milk for the first six months, or it might be to exclusively breastfeed until the baby is a year old. We want every child at CHOC to receive optimal nutrition. For the newborn, infant and young child, we support breastfeeding and breast milk use. We firmly believe it when we tell our families that breast milk Is medicine.

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Frozen Breastmilk Safety 101

By Caroline Steele, board-certified lactation consultant, board-certified specialist in pediatric nutrition, and registered dietitian at CHOC Children’s

Caroline Steele, director of clinical nutrition and lactation at CHOC Children’s

CHOC has board-certified lactation consultants as well as certified lactation educators available to assist breastfeeding or pumping moms. Many of our other staff members, including nurses, dietitians and developmental specialists, can also assist families with breastfeeding and pumping, and many have specialty lactation training.

Because nutrition is one of the most important factors in a baby’s health, CHOC Children’s provides lactation services to mothers who wish to breastfeed or pump while their baby is in the hospital.

Here are answers to some of the most common questions we receive on frozen breast milk safety.

Can breastmilk be frozen?

Yes, breastmilk can be frozen and should be frozen if it won’t be used right away (similar to what you would do with other foods).

What is the safest way to freeze breastmilk?

  • For preterm or hospitalized infants, it is generally recognized that milk that will not be used within 48 hours after it is pumped, should be frozen. For healthy babies at home, it is possible to store freshly pumped milk in the refrigerator for 5 days before needing to freeze it.
  • Milk should be frozen in rigid plastic bottles or plastic bags specifically designed for breastmilk storage. Plastic bags are not recommended for hospitalized infants because they are prone to leaking and are more difficult to handle in the hospital setting.
  • Freeze milk in volumes that the baby would normally eat so that once it is thawed, none is wasted.
  • Never add freshly pumped milk to a bottle already containing frozen milk. Newly pumped milk should go into its own container.

How long can breastmilk be frozen?

  • If freezing/storing breastmilk in a combination refrigerator/freezer unit, the milk should be stored in the back of the freezer to keep it from being exposed to temperature fluctuations when opening and closing the freezer door. In this type of unit, the milk may be stored 3-6 months.
  • If freezing/storing breastmilk in a deep freezer that can maintain a temperature at or below zero degrees Fahrenheit, it may be stored for 6-12 months.
  • Once frozen milk has been thawed, it must be used within 24 hours or discarded.

I’m giving my baby frozen breastmilk. Are there any risks I should know about?

  • It is best to use the oldest pumped milk first to prevent milk from being frozen too long.
  • Some of the immune enhancing properties of breastmilk are decreased over time when milk is frozen. However, the risk of bacterial contamination of milk that has been kept in the refrigerator too long and not frozen, far outweighs the downside of freezing milk.
  • Sometimes there are slight changes in the taste and smell of milk that has been frozen due to the enzymes naturally present in breastmilk. Those changes are not harmful and don’t matter to most babies.  However, some babies do have a noticeable preference for milk that has not been previously frozen.
Get more helpful tips about lactation and breast milk

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The Latest Guidelines for Introducing Solids to Babies

Many parents are familiar with this scene: It’s dinner time, and your baby is eyeing every bite of food you put in your mouth. Is it time for baby to try solid foods?

Solid foods can be introduced as early as six months of age, according to guidelines from the American Academy of Pediatrics and the World Health Organization. That’s when a baby’s digestive system is developmentally ready for food. Prior guidelines recommended starting solids at four months, but research has shown that introducing solid foods earlier could increase the chances of developing diabetes, obesity, allergies and eczema, according to Vanessa Chrisman, a pediatric dietitian at CHOC.

Age is not the only requirement for solid foods. A baby should also show the following signs of readiness: they can hold their head up, they can sit up without support, they can close their mouth around a spoon, and they no longer reflexively push things out of their mouth with their tongue.

“If a baby spits the food back out with her tongue every time a parent offers food, she’s probably not ready for solids yet,” says Chrisman.

At first, solid foods are more for practice and exposure to new flavors and textures, rather than for nutrition. A baby’s main source of nutrition will continue to be breast milk or formula up until one year of age. As a baby eats larger amounts of solid food and approaches the one year mark, they may begin to drink less breast milk or formula.

Introducing Solids to Babies

Solid foods are traditionally introduced in puree form. Single foods are blended to a smooth consistency and fed by spoon. As a baby eats larger volumes and tries more foods, parents can move on to a thicker texture: mashed foods. At around nine or 10 months old, a baby may start eating finger foods in small pieces.

Baby Led What?

Another method of introducing solid foods to babies is called baby-led weaning (BLW). This method has been popularized in the United Kingdom over the last decade and is starting to gain popularity in the United States.

“Baby-led weaning is a way of introducing solid foods beginning with whole but manageable pieces, and skipping purees and mashed foods,” Chrisman says.

Babies are offered foods that the rest of the family is eating, except for choking hazards such as whole grapes, hot dogs, raw carrots, popcorn, nuts, raisins and very tough meat. Parents can cook and spice the food as they normally would for themselves.

BLW teaches baby to feed themselves, helps them develop motor skills and gives them control over how much food they want and if they want it. “If they’re the ones deciding when to stop eating, it can help them regulate their appetite later,” Chrisman says.

A recent study by the AAP determined that babies are not at a higher risk of choking from BLW than they are with traditional purees. Regardless of the food method, it’s always a good idea for parents to know infant CPR, Chrisman says.

As with puree-fed babies, BLW babies must meet the same signs of developmental readiness before starting solid foods. One thing a baby doesn’t need, though, is teeth. “Babies have strong gums that can soften food, along with their saliva,” says Chrisman.

Chrisman recommends that parents choose the method that fits their baby’s personality. An independent baby may take to BLW more than a baby who prefers to be spoon-fed. The key to remember is that every baby is different: “What might work for your friend’s baby might not work for your baby,” Chrisman says.

Straight from a Pediatric Dietitian

Chrisman offers these expert tips to parents as they introduce baby to solid foods:

  • Introduce simple foods one at a time, such as individual fruits, vegetables and proteins. Wait at least three to four days before introducing another food, to watch for adverse reactions. “Don’t go too fast, too soon,” Chrisman says. “Your baby has their whole life to eat all these foods.”
  • As solid foods are introduced, give baby a variety, which will help ensure they will like a variety of foods later in life.
  • Don’t add salt or sugar to baby’s foods. Not only could this cause baby to develop a taste for these strong flavors, it also prevents baby from experiencing the true flavor of a food.
  • Model healthy eating habits. Include a variety of healthy foods on your own plate so baby will learn to imitate your behavior. Encourage your family to sit at the table together and put away distractions so baby understands what meal times should be like.
  • “Make sure feeding time is a relaxing time, not stressful,” Chrisman says. Don’t force baby to eat more than they want and pay attention to their signals. If they are throwing food off their tray, pushing food away or turning their head away, they are done.
  • Feed baby solid foods in between their regular mealtimes, when they’re only somewhat hungry. A hungry baby won’t have the patience for solid foods to reach their tummy.
  • Avoid honey for babies under age one. Honey can carry spores that cause botulism, which is dangerous for infants.
  • Avoid fruit juice before age one. A recent change in AAP policy says fruit juice should not be given unless a doctor recommends juice to manage constipation. The high sugar content in juice may increase a child’s risk of obesity and teeth problems.
  • Avoid cow’s milk before age one. Cow’s milk should not be given on its own, according to the AAP, though it may be fed in other foods, such as whole fat yogurt.
  • Don’t give up on foods that baby rejects a few times. It could take up to 15 times of trying a food before they like it.
  • If baby isn’t eating any solids or purees by 10 months of age, talk to your pediatrician. There could be a feeding issue that needs extra help. Some babies may have an oral aversion to foods, oral motor dysfunction, textures issues and/or poor muscle tone.

How to Help Babies with Reflux

Some baby spit-up is a fact of life for parents of infants, but a baby who spits up a lot or often may have reflux, a CHOC pediatrician says.

Reflux is a condition wherein food comes back up into the esophagus from the stomach. This sometimes happens to babies because their gastrointestinal tract is immature and has not fully developed yet, says Dr. Mary Ann Wilkinson, a pediatrician and chief of staff at CHOC at Mission Hospital.

In normal eating, muscles at the entrance to the stomach should relax to let food in, then close to keep the food in the stomach. However, in babies, the muscle can be loose and allow food back into the esophagus, she explains.

Common in babies, reflux can start as early as one to four weeks of age and typically resolves by six to 12 months of age, Dr. Wilkinson says.

She advises parents to discuss reflux with a pediatrician if the baby is spitting up so much that he isn’t gaining weight well and/or the baby is in pain.

Stomach acid coming up into the esophagus can give babies heartburn, which can be painful, Dr. Wilkinson says.

“The food and acid comes back up causing pain and crying,” she says. “They might arch their backs and not eat as much to try to reduce the pain.”

Dr. Wilkinson offers some reflux prevention and treatment strategies:

  • Avoid overfeeding babies.
  • Burp the baby well.
  • After feeding, sit the baby upright for 30 to 60 minutes so gravity can help keep the food in the stomach and reduce the chance it will come back up.
  • Breastfeeding mothers should abstain from gas-producing and caffeinated foods. These are passed to the baby through the breast milk and can trouble a baby’s digestion.
  • Formula-fed babies can be given a special formula that is easier to digest.
  • Formula can be thickened with a little rice cereal to make the food heavier and more likely to stay in the stomach.

If these treatments don’t work and the baby doesn’t improve or becomes worse, medication can be used, Dr. Wilkinson says.

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Healthy, Safe Sleep for Baby

baby not sleepingAs new parents often find, no one in the house sleeps if the baby doesn’t sleep. It’s very common to have sleep troubles with a baby, especially as new habits and routines are being developed.

Newborns and babies should get the recommended amount of sleep based on their age. These recommendations are only guidelines and not every baby will follow them:

Birth to 6 months – 9-12 hours at night (waking through the night to feed) / 2-8 hours during the day

6 months to 12 months – 10-12 hours at night (usually sleeping through the night) / 2-5 hours during the day

What if my baby has trouble sleeping?

The following are some helpful tips for establishing good sleep habits for your baby:

  • Newborns do not have a set night or day schedule for the first several weeks of life. It is best for a newborn not to sleep longer than 5 hours at a time in the first 5 to 6 weeks as their small bodies need frequent feedings.
  • Older babies should have a nap time and bedtime schedule. Put your baby to bed at the same time each night.
  • Babies should not be put to bed with a bottle. It causes problems with tooth decay and ear infections.
  • At bedtime, include quiet activities your baby likes, such as a bath, a story and a last breastfeeding or bottle. Avoid playing with and stimulating the baby.
  • Answer your baby’s cries on a schedule. Wait a few minutes longer before each response on a single night, or before every response on succeeding nights. Your baby soon will learn to fall back asleep on his or her own.
  • Swaddle your baby. Swaddled babies often sleep more deeply, are startled less often and fall back to sleep more easily. Learn how to swaddle your baby.

Preventing SIDS

Sudden infant death syndrome (SIDS) is a very real sleep-related risk for babies under age 1. Here are recommendations from

Image courtesy of Safe to Sleep campaign by the National Institute of Child Health and Human Development
Image courtesy of Safe to Sleep campaign by the National Institute of Child Health and Human Development

the American Academy of Pediatrics (AAP) on how to reduce the risk for SIDS:

  • Make sure your baby is immunized. An infant who is fully immunized reduces his or her risk for SIDS.
  • Breastfeed your infant. The AAP recommends breastfeeding for at least 6 months.
  • Place your infant on his or her back for sleep or naps. This can decrease the risk for SIDS, aspiration and choking. Never place your baby on his or her side or stomach for sleep or naps. If your baby is awake, allow your child time on his or her tummy as long as you are supervising, to strengthen the neck and head muscles.
  • Always talk with your baby’s doctor before raising the head of their crib if he or she has been diagnosed with gastroesophageal reflux.
  • Offer your baby a pacifier for sleeping or naps, if he or she isn’t breastfed. If breastfeeding, delay introducing a pacifier until breastfeeding has been firmly established.
  • Use a firm mattress (covered by a tightly fitted sheet) to prevent gaps between the mattress and the sides of a crib, a play yard or a bassinet. This can decrease the risk for entrapment, suffocation and SIDS.
  • Share your room instead of your bed with your baby. Putting your baby in bed with you raises the risk for strangulation, suffocation, entrapment and SIDS. Co-sleeping is a culturally variable practice. It can be safe under some very strict conditions, such as eliminating blankets and pillows from the bed. Parents are at higher risk for rolling over a baby if they are overweight, smoke, do illicit drugs or drink alcohol. If you are considering co-sleeping, please be sure to discuss the guidelines with your doctor.

Although reported use of blankets and other bedding for infants continues to decline, about half of U.S. infants are still placed to sleep with potentially hazardous bedding, according to a study in the latest issue of Pediatrics, published by the AAP.


  • Avoid using infant seats, car seats, strollers, infant carriers and infant swings for routine sleep and daily naps. These may lead to obstruction of an infant’s airway or suffocation.
  • Avoid using illicit drugs and alcohol. Don’t smoke during pregnancy or after birth.
  • Avoid overbundling, overdressing or covering an infant’s face or head. This will prevent him or her from getting overheated, reducing the risks for SIDS.
  • Avoid using loose bedding or soft objects. Bumper pads, pillows, comforters and blankets should not be used in an infant’s crib or bassinet to help prevent suffocation, strangulation, entrapment or SIDS.
  • Avoid using cardiorespiratory monitors and commercial devices. Wedges, positioners and special mattresses should not be used.
  • Always place cribs, bassinets and play yards in hazard-free areas. Avoid dangling cords or wires to reduce the risk for strangulation.

Visit the Sleep Disorder Center on to learn more about healthy sleep for kids.

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