Talia at 18 months

Doesn’t time fly? It’s hard to imagine that a year ago this gorgeous almost-toddler was almost failing to thrive, and I was struggling with post-natal depression as a result.

Now she’s a little above the 10th percentile at 9.33kg and 74cm long, and has made the move into size 0 and size 1 clothing. I pulled out her summer clothing from last year and marvelled how 000 could look so small, when at first we could hardly imagine she would ever be big enough to wear it. We’ve come through winter with only two minor colds, which is fantastic given that she left hospital with chronic lung disease.

Developmentally speaking, Talia still exhibits global delays, but they do not stop her enjoying life immensely. She is nearly walking, having taken her first few steps, but is happier crawling at the moment - including some new crab walking with her bottom in the air. She recently started baby swimming classes (known here as “synchronised splashing”) and hopefully that will help her core body strength as well as giving her confidence around water.

Her favourite activities at the moment are going on the swing in the park, reading books, playing with balls, pegs and balloons, popping bubbles, starting games of peek-a-boo and hanging out with her bath toys. She has recently grasped the concept of putting pieces into a simple jigsaw (no interlocking pieces) but doesn’t have the dexterity to complete it by herself just yet.

Eating is still patchy, with the same problems of “loved it yesterday, hate it today, don’t even bother tomorrow”, but she’s continuing to gain (and grow out of things) despite the fact that she’s almost 100% self fed on finger food and I’m no closer to getting her to eat off a spoon, regardless of whether I’m holding it or she is. On the positive side, we can feed her a little bit of whatever we are having and no longer have to rely on food organised specifically for her (although we still do to some extent), and we’ve moved from formula to cow’s milk in the last month without any problems - in fact she clearly prefers it.

She will sometimes allow us to brush her teeth but it does take quite a bit of persistence. She sleeps well overnight and has one nap in the middle of the day, usually 1-1.5 hours long. I wish she’d sleep longer during the day but no luck so far - her room is probably not dark enough.

All in all, a wonderful, easy-care baby, even if she came without a manual! We feel very fortunate, and very proud.

Premature girls get more from breast milk

Premature baby girls appear to get greater benefit from breastfeeding compared than premature baby boys, according to new research.

Researchers from Johns Hopkins University in the United States tracked a group of premature infants in Argentina to gauge the protective effect of breastfeeding against respiratory infections in babies.

The results of their research are published in this month’s edition of Pediatrics.

They found that infant girls who were breastfed were far less likely than baby boys who were breastfed to develop serious respiratory infections requiring hospitalisation.

Previous research has shown that breastfed babies receive a range of health benefits compared to those given baby formula.

These range from combating respiratory infections, fewer ear, stomach or intestinal infections, digestive problems, skin diseases and allergies.

“There are many, many different diseases that are protected against by breast-feeding. It’s a great source of nutrition,” Dr Fernando Polack of Johns Hopkins University says.

“In the specific case of acute respiratory diseases like bronchiolitis and viral infections of the respiratory tract, it seems that there is greater benefit in girls than in boys. And that benefit is substantial.”

Breathing easier

Bronchiolitis is an infection of the airways of the lungs seen most often in infants between about 3 and 6 months old.

The researchers studied a group of 119 high-risk infants who weighed under about 1.5 kilograms at delivery. This population is highly susceptible to these kinds of infections, Polack says.

Fifty per cent of the baby girls who were formula-fed had to be hospitalised when they experienced their first respiratory infection, compared to about 7 per cent of the girls who were breastfed, the researchers write.

There was no difference between the boys who were breastfed or formula-fed, with about 19 per cent of both groups needing hospitalisation when they got their first respiratory infection, the researchers said.

The pattern repeated throughout the first year of life and in subsequent infections, the researchers say.

Polack said there may be something in the breast milk that better activates a baby girl’s ability to cope with such infections more so than it does for a baby boy.

Article from ABC Science 

The great spoon strike of April ‘08

Since she figured out solids at the end of last year, Talia has been fantastic, eating all sorts of homecooked meat and veg. She had started to catch up with her weight and all was going well… until now.

A week or maybe a little longer ago, she started objecting to receiving food on a spoon, pushing it away with her hands and turning her head to the side. With a bit of ingenuity (”say aaah Talia!”) I could get a spoonful in, and after carefully digesting this first mouthful with all the seriousness of a wine connoisseur judging expensive shiraz (up to but not including the spitting out stage), she would then allow me to feed her the rest of the meal.

I thought I had it all under control until the beginning of this week, when she decided that not even the first spoonful would be considered acceptable, under any circumstances. It has been very difficult to deal with, as I don’t want mealtimes to be a fight, but I can’t let her go without a healthy diet. It’s not that she won’t eat - just that she won’t allow herself to be fed. It wouldn’t matter so much if she was older and able to use a spoon, but at the moment she will only accept a limited range of finger foods - and they are subject to change without warning. Savoury pikelets were a hit on Tuesday but thrown out of the high chair on Wednesday. Raisin toast has come back into favour, as have avocado finger sandwiches, but baked ricotta is now out and her acceptance of random veges appears to depend entirely on her mood, the phase of the moon and whether or not the wind is blowing from the west.

This is the sort of point where you realise that being a mother is a full time job and then some.

Good to the last drop

The bottom drawer of our freezer (we have an “upside-down” fridge) belongs to Talia. It’s full of plastic tubs containing ice-cube-sized portions of stewed fruit, mashed veg, pulverised chicken, flakes of fish in cheese sauce etc. Wedged in the middle of this oyster of solids was a little pearl - the last remaining bottle of my frozen expressed breast milk (EBM).

I’ve rambled at length about the ups and downs of milk production. It wasn’t easy, but it was worth it. I wanted to do more, but now I’m happy that I did as much as I could. If I had to do it all over again, I would. So what’s the story with this bottle of EBM? Talia stopped breastfeeding exclusively last October, and ceased completely at the end of January. It’s now the end of March. This bottle of liquid gold was dated 21/6/07 - the day before Talia came home from hospital. This bottle of milk has reigned, happy and glorious, over the bottom drawer of the freezer for NINE months, as one by one all the other bottles (older) and baggies (younger) of EBM were defrosted and used up. (Don’t worry, my freezer is cold enough that it was safe to keep it longer than the usually recommended three months). This bottle was a testament to my hours of expressing but also a life-line which I had clung to for months in case of emergency, but which was no longer needed now that Talia is healthy and happy with formula and solids.

So last Thursday, a week after Talia’s first birthday, I liberated this vintage bottle from its cryogenic home and defrosted it. On Saturday, Talia’s bottles were half formula and half EBM, the final instalment of my first gift to her. It doesn’t usually happen, but she completely finished every bottle. That night we both went to sleep satisfied.

7 months corrected and eating, eating, eating…

I browse a number of websites for parents of premature babies, and the topic of “when should I start my premature baby on solids” comes up time and again. Some people believe you should go by corrected age, others feel that actual age is appropriate because prem babies are digesting milk from very soon after birth. However, regardless of which side you take, the fact remains that if your baby is not ready to eat, no amount of coaxing and saying “yum, yum!” is going to help.

When Talia was not thriving on just breast milk, I consulted the lactation consultants from the NICU, who suggested I start Talia on solids at 4 months corrected (7 months actual) rather than offer formula. What a joke! Talia was nowhere near ready to start, and my efforts only ended in frustration for me and bewilderment for for my baby. In contrast, she took to the formula like it was nectar of the gods.

Time passed, and every few days or so I would patiently offer up a spoonful of Farex. Perhaps if I’d tried it myself I might have realised how unlikely Talia was to ever show any interest in it. Her expressions of disgust said it all.

I lovingly cooked up pear, sweet potato and pumpkin, pureed it and froze it into ice cubes. I could sneak a smidgeon past her lips - but no more and no further. I expanded the repertoire to include apple, carrot and potato, and suddenly she would eat a cube, and I would think “yes, we are making progress”… but then she would reject the exact same fruit or vegetable the following day.

Somewhere around 6 months corrected (9 months actual) Talia started to accept about 1-2 cubes per day. I had a hit with pumpkin and avocado, figured out how to put peas and corn through the sieve and was starting to feel I was making progress, although it was hardly going to put any weight on her compared to the formula, and her tongue reflex was still strong, so I was spooning in food then having it pushed straight back out again, even when she seemed to enjoy the flavour.

Then, at almost 7 months, something clicked for Talia. Maybe it was when I started to blend more flavours, maybe it was the introduction of roast chicken or maybe it was just the way the planets were aligned, but suddenly she wanted MORE FOOD and she wanted it NOW.

In the last week, Talia has eaten 3 or 4 meals a day, including at least 2 with meat and veg. (She seems to prefer this to fruit, either mashed with milk, with farex or with yoghurt). She demands to be fed, and leans forward with mouth open to take the next spoonful. It goes in and it stays in - and the proof is in the pudding, so to speak. I had her weighed on Monday and she’d put on 405g in 2 weeks. Not bad for a baby who regularly put on only 30g/week on breastmilk.

I feel as if a difficult chapter of Talia’s journey - the section where I worried myself to the point of depression about her lack of weight gain - is finally over. At the same time, our breastfeeding routine has dropped down to one feed per day, first thing in the morning. Its days are numbered, and I feel a tinge of sadness that this part of our relationship will soon be over, but I am happier to let it go knowing that Talia is making progress in other areas.

When a mother’s milk is not enough

I never realised just how emotional I was going to get about breast milk. 

I remember the obstetrician asking me if I planned to breastfeed, minutes after he had told me I might be having a baby at 26 weeks.  Yes, I replied sadly, assuming it would be impossible to produce milk under the circumstances, not realising that simply parting company with my placenta would trigger changes to the hormones in my body and kick start milk production. 

For three months my life revolved around expressing “liquid gold”, which is a story all in itself.

The lactation consultants in the nursery spent hours helping me to coax my reluctant daughter to suck while encumbered with CPAP and feeding tubes.  Tears flowed freely – more freely than my milk some days!  Naively I had assumed that breastfeeding would be natural and instinctive, but for me it was a struggle.  At the same time, it was one of the few things I could do to help my precious baby grow strong and come home, and so it became more important than anything. 

I felt a great sense of achievement when I was finally able to breastfeed my daughter in the comfort of my own home, and as I relaxed I began to enjoy it more and more.  However my joy and confidence were undermined by the inescapable fact that although my baby was gaining weight, it was only 30-40g per week - well below desirable levels.  I consulted everyone: the breastfeeding centre, a local lactation research group, a string of child health nurses, the internet.  I did everything they suggested to increase supply and improve my feeding technique, but it made no difference.  She looks healthy but over four months my little one has slipped steadily down the growth charts.  Amazingly, every time I queried this with a child health nurse or lactation consultant, they told me not to worry about it because she was doing fine “for a prem”. 

Finally, she fell below the lowest line on the chart and I was forced to confront the reality that as much as I loved her, my milk alone was not enough to keep her going.  There’s no objective reason why it should bother me so much to give my baby formula.  I know it’s an adequate alternative, and for that matter I was formula fed myself.  Why is it so hard to shake the sadness within me, as if I have somehow failed one the most basic jobs of motherhood? 

I am trying to see the positive. Thank goodness for the blessings of the modern age, which enable our children to survive and thrive when our bodies let us down.  And unlike EBM, at least I can tip formula down the sink without any regrets.

The Joy of Ex (pressing)

The other day I discovered the wonderfully cheeky League of Maternal Justice, committed “to expose the injustices perpetrated against mothers everywhere and to exact vengeance through aggressive finger-wagging and online shaming”.

Superhero Lactavista single handedly defends breast feeders with her super action nursing bra and double power breast pump, but what made me smile was the way she is shown clutching an expressing bottle and breastshield, like a weapon of mass milksuction. My husband always said they looked like science fiction rayguns. 

Enough milk has passed under the bridge, so to speak, that I can look back on the three dedicated months I spent expressing and smile about it. It wasn’t always so easy.

From the day I was first introduced to a breastpump, I became a woman (or possibly a cow) on a mission, pumping every three hours around the clock. A sample of my daily routine: pump, sleep, pump, eat, pump, visit hospital, pump, wash expressing gear – well you get the picture. The only exciting thing I did during those three months was to pump, rush to attend pop concert, queue to meet pop star, hug pop star (woo hoo!), rush home, pump again. Other than that it was pretty darn dull.

Our cat took an immediate dislike to the vibrating machine of similar size to him and which seemed to be a rival for my attention. He would often glare at it, purring extra loudly so that I would hear him above the whirring of the pump.

Before I started taking Domperidone (known affectionately in our household as Dom Pérignon) my milk supply was woeful, and it never really took off. Where others squirted, I merely dribbled. I envied the mothers whose freezers overflowed, as I carefully syringed out every last drop and took photographs the first time I filled a container larger than a test tube.

Cry over spilt milk? You bet I did.

I spent lot of time surfing the web while expressing in the middle of the night. I found a lovely story about another woman’s experience, called Help! My Breastpump is on Fire

When I finally parted company with my hired pump, I almost felt a tiny pang of sadness – but only for a millisecond. If I ever have to set my alarm to wake me at 3 a.m. again, I hope it will be for something a lot more exciting.

Rethink on breastfeeding, allergy link

TONY EASTELY: Australian researchers say if mothers exclusively breastfeed their babies and there is a family history of allergies, it may actually increase the babies’ chances of developing allergies in later life. The study authors say while breastfeeding has many other benefits, it will not protect children against asthma and allergies in the long-term. But some experts aren’t so convinced and they say the results of the study are inconclusive. Barbara Miller reports.

BARBARA MILLER: The current recommendation is that babies should be exclusively breastfed for six months. One of the most-cited benefits of the breast is best policy is that breastmilk helps protect against allergies.

But researchers from the University of Melbourne, who’ve carried out a longitudinal study on 8,500 people, say that’s not necessarily the case for babies where there’s a family history of allergies. Dr Melanie Matheson from the University’s School of Population Health.

MELANIE MATHESON: We found that breastfeeding in the first three months of life protected against asthma and allergic disease before the age of seven but it no longer protected against those conditions after the age of seven. Our study followed our cohort up until the age of 44 and we found that the risk of asthma and allergic disease continued to increase right up into middle age.

BARBARA MILLER: The researchers say the increased risk is small, but they say their work does call into question the current guidelines on breastfeeding. But some experts say the work is inconclusive. David Thomas is Chair of the Child Youth Health Committee at the Australian Medical Association.

DAVID THOMAS: Their study really needs to examine whether they’ve looked at all other external variables. Allergies later in life can be predisposed to by a number of other environmental impacts which are quite independent of breastfeeding. So, if they’ve found an association, they really need to look at all the other factors ’cause it may or may not be related to breastfeeding.

BARBARA MILLER: That’s a view shared by Dr Andrew Pesce, Clinical Director of Women’s Health at Westmead Hospital in Sydney.

ANDREW PESCE: Children who are exclusively breastfed are often being looked after in the home by their mother. They may have a lower incidence of going to childcare early in life and being exposed to various infections in life. Those infections may challenge the immune system and have effects, both harmful and beneficial possibly, that we don’t fully understand. Hygiene is another thing.

So, you know, there are a whole lot of potential compounding factors which make it really difficult to know what aspect of the breastfeeding and the link to allergies story is breastfeeding alone.

BARBARA MILLER: Do you think that women should change their behaviour based on the results of this study?

ANDREW PESCE: Look no. I think that, you know, this is an incremental addition to the understanding that the researching scientists are giving us and there’s nothing in this information which would make a woman have to think that she has to, you know, change what she’s been doing so far.

TONY EASTELY: Dr Andrew Pesce, Clinical Director of Women’s Health at Westmead Hospital. That report by Barbara Miller.

Transcript from ABC AM radio 

Breast Milk Banks

Doctors Call For Breast Milk Banks

Neonatal specialists say the lives of many premature babies could be saved if there were more breast milk donation banks in Australia. The first national breastfeeding conference is being held in Melbourne and will today hear about the success of the milk bank at Perth’s King Edward Memorial Hospital. The bank opened a year ago and has provided 55 premature babies with donated breast milk.

The bank’s manager Dr Ben Hartmann says breast milk is better for the immature immune and digestive systems than artificial formula. “When a mum does give birth prematurely, there can often be several reasons that she can’t provide her own breast milk,” he said. “During those days we need to feed babies intravenously so if we can actually provide donor milk and get those babies onto full feeds, mum’s milk then comes in and she can take over. “It means we can get those IV lines out and that’s a potential source of infection for babies.”

Dr Hartmann says the lives of more premature babies could be saved if there were banks in other cities. “Babies in our unit will be down to 23 weeks or 24 weeks gestation, I guess their immune system and their digestive system is quite immature,” he said. “We need to provide nutrition that’s appropriate and in easily digestible forms but we also know that breast milk contains a lot of immunological protective properties.”

Article from ABC News