Questions to our lactation consultant Karin Tiktak

Karin is 48 years old and the mother of 3 children and 2 bonus children.
In addition to her job as a consultant and teacher, she worked for years for the Breastfeeding Association. Now she has been running her own lactation practice since 2005.

In order to help and advise mother and baby in problem situations, she goes to their home visit. You can also contact Karin for advice on flasks. In addition, she provides a private course "Preparing for Breastfeeding" to prospective parents on request.

Ask your question

Do you have a question for Karin? Place your question in the comment field at the bottom of the page. Karin will also place her answer there.

Our visitors asked her the following questions:

From Monday evening I pump ten minutes after the last feeding and ten minutes after the first feeding with a double electric flask (medela mini electric plus). That gives me 25cc.
today (Thursday morning), the amount of undulated milk has not yet increased. chest compression had no result. do I have to pump for ten minutes 1 day after each feeding? is there anything else I can do to get it up?
For the next three months I want to go to the situation where I can stock up in the morning and in the evening and give the baby full-time breastfeeding.

Answer
My first question is, how old is your baby?
With a young baby (first weeks) it is not at all crazy that you do not rave much. The production is mainly adjusted to your baby, so you make exactly what your baby drinks. In addition, your baby standard is growing, so you could always ask for more. if you are in that ascending line, there will often not be too much to poke about. So it seems that your production does not increase, but in reality it happens, only your baby drinks more (or faster).
I also have the question how often you feed and how your baby grows.
You can also change your flask rhythm. For example, pauses. Alternate in single-sided / double-sided, turn it down softly (often the power is much high to pump as fast as possible - which is counterproductive) Use heat for pumping. Or flask at the same time as feeding your baby. You can also pump more often what you imagine, but that has a considerable impact on your day. Grab moments where your baby has a pattern of a little longer time in between to briefly pump in between.
further, there are women who do not pumping so much, adjust your expectations. Just think that after 4 days a 7 days you have an extra diet together. So 3 power supplies in 3 weeks. This is very normal. (so many women build up a stock of 4 supplies in a month before they start working.) Good luck!

My son reacted very strongly to the vitamin d and k on the 8th day.
This was also the case with my 1st son. Have the internet scourged and it appears to be more common.
Now my question is:
Can I as a mother now swallow those vitamins so that they get enough through breastfeeding?
After 10 weeks you will make vit.k. and for the d they will soon be outside.
So I am mainly interested in the vitamin k.

Answer
There is no point in taking vitamin K yourself to create an increase in your breast milk. You already make vitamin K, so there is already a small amount of Vitmine K in your milk. To be precise: In the first 5 days (colostrum), mm contains 0.23 micrograms per 100 ml of Vit K, after which it increases slightly to 0.25 micrograms per 100 ml of 30 days. Some parents therefore choose no supplementation with vitamin K. That is their own choice. I as a certified lactation consultant follow the advice of the Nutrition Council.
Vitamin D is not measurable in colostrum, in 30 days mm just a trace. What is known is that fattier breast milk contains more vitamin D. Vitamin D should also be supplemented by the mother during the lactation period, for your own reserves. the baby also needs extra vitamin D. From sunlight, in our country, and certainly with winter coming and the high degree of coverage of the body and the pram, for example, a little extra D! Maybe agree with a doctor about an alternative administration?

I have a 3-week-old daughter. Born 41 weeks with 4kilo weight. From the very first day she falls asleep during feeding. She literally drinks 1 to 2 minutes and falls asleep. We try everything to wake her up (change clothes, clothes, hands / feet / throat etc rubbing, cold washcloth), but it does not help. She is very fast asleep. Now she had lost a lot of weight and did not come on so I started with flasks and we give her the food in a bottle. This keeps her awake. She also gave a lot of milk back, with the bottle this has become slightly less. My questions now:
- is it wise to pump in this way?
- if I lay her, she will bite and let go again ... All the time ... What does this mean?
- what about rain days and flasks?
Thanks in advance!!

Answer
You have not solved it properly by pumping, so she gets your milk and the production does not go back either. Check for thrush in her mouth. You might also be able to improve the mooring, because it does not let go for nothing. Sometimes the milk can go too fast or too slow. it is difficult to assess this by mail. Perhaps a lactation consultant to come to home visit?

I have a 16-week-old daughter. She was born prematurely and was dysmature. 36 week 1860 grams. After a lot of flasks and use of nipple caps, she can finally drink for two weeks without a nipple cap. We regularly passed her a bottle (called an "active"). Advice from CB so that if I go back to work or have to leave, she can drink from the bottle.
Now it is finally pretty good to sleep with grandpa and grandma (the babysitter later) now she does not want the bottle anymore !! She suddenly refused him. I try to give a bottle every day but she does not want to, if she then lies in bed again after playing (because she no longer wants breastfeeding), she cries so long until she gets the breast. I have to work in three weeks, and how should that be? It is just a little better (crying baby) and now this problem. She gets upset (and I) completely.
I hope you can help me.

Answer
This is a difficult problem. The solution is not ready, but these are a number of tips. First build up both trust again. Do not try a bottle for a day. Patience is really very important. Then try again, keep it positive. Keep encouraging calm and friendly. Someone else can give the bottle, but also you or your husband. You can try it in the arms while walking. Or if you have her in a baby carrier, for example, and she almost falls asleep. Or put in a pinch. But avoid frustration and howling, because that is really counterproductive (and then it will take longer). Another way is to offer the bottle in a playful way. Wrap it in a brightly colored paper or with a rattle on it, do not put milk in it and let your baby look at it from a distance, then rummage and finally suckle. If she accepts the bottle teat once as an interesting sabbelspeleltje, then you can again sweeten some milk and give her something. Price her the werled if she takes a sip. Good luck!

I would like to breastfeed for a maximum of 2 weeks. Then I find 2x per day maximum enough or perhaps not at all and full bottle.
Now my question is; how do I deal with that? Immediately start with a supplement or after 4 days i replace 1 breast with bottle and then reduce it?
Thanks for your comment.

Answer
If I understand you correctly you want to start breastfeeding. That's nice, so your baby can get his first natural 'inoculation' with colostrum and you limit the risk of many types of infections. In order to optimize this start, you start with breastfeeding. So immediately after birth, provide skin-to-skin contact and give your baby and yourself the time to look for the chest and try the first. The first few days are to get breastfeeding going. After day 3 a 4 you will probably get stowage and then more milk will automatically be available for your baby. It is therefore very important to lay your baby about 7-8x per day, so your baby gets enough inside and your breasts are emptied well and prevent blockages. During those days that follow, milk will be made if your baby requests it. That is called the demand-supply principle. In that case I would look at how things are going after 1 week in your case. How did you recover after delivery? How is your baby? Do you enjoy breastfeeding? Is the start difficult? How do you feel? how do you feel breasts? Are you hurt? How do you look at it then? it is often very difficult to determine in advance. So if you think after a week, I keep my idea, then you can start reducing. Replace 1 power supply through the bottle. Because you do that soon after birth, the reduction is often quick. So after 2 days you look at how your baby is doing, how does he / she respond to the artificial food, how do you react to breasts and then you can replace a food, etc. Reducing your baby's breasts is done by baby and breasts. By that time you have all kinds of experiences, feelings and thoughts and you probably also have your maternity nurse and verloskunidge who gave you advice. If you still have questions by then, I will hear it. You can also call me.

I would like to combine FV and BV because I only find BV quite heavy. My son still comes every 3 hours and then drinks half an hour (he is 4 months). How can I best start combining? Do I get a lot of trouble with stowage?
He occasionally gets a bottle once in a while, and he responds well to that.
Thanks in advance for your response.

Answer
Before I will answer, I want to give you the following for your consideration.
'Every 3 hours' is perfectly normal for a breastfed child (aged up to 6 months). It is not the babies, but the producers of FV who have thought to increase the amount of food at a time so that there must be 4 hours between them ... And do not be fooled by your environment who is wondering for the umpteenth time: comes he still every 3 hours ??? (as if it is strange that I would have a cup of coffee every two (!) hours ...) You write that your BV is going to be quite heavy. Check what exactly "heavy" is for you. Is it because you are constantly busy with the power supplies? Or is life with a young baby quite heavy? Do you come to your rest by just sitting down to feed or is the combi work and care heavy and is you still often disturbed in your sleep during the night?
Some think that you will get a lot in return by finishing ...
As care providers, we are obliged to point out the health risks of FV, hence these pedantic texts ...
If you consider making your choice well, then of course it is entirely up to you and your baby, and it works as follows.
Choose a diet that is already somewhat more difficult (because it seems to be less saturated) or that you will find the best in terms of time planning, to replace first. Usually this is a late afternoon food or early evening meal. Your breasts are therefore the least stung. Watch this 3-7 day or your breasts feel smooth again. If you give an FV, then look carefully how much your baby wants to drink from it (that is what he is used to). Then you can replace a different diet, for example the late evening diet (if there is another BV in between) around 10 a 11 o'clock . Or, for example, the late morning food. Depending on your own wishes and possibilities, you can still replace one, as long as you keep on spreading and doing it gradually. Take a good look at your baby, and always feel whether your breasts stay supple. Good luck!

My daughter is exactly 1 month old now and I am fully breastfeeding. I pump the most off, because my daughter has spruw and that does quite a lot of pain. Now I have the idea since 2 weeks that they do not have enough more food 110 cc. After about half an hour she starts to moan and if I give her the bottle or breast then she gulps so eagerly and drinks with big strokes. Could it be that my diet is not feeding enough? My daughter had grown well the last time at the clinic, but I am with an uneasy, crying child from about 6 pm to 11 pm. How do I know if she receives sufficient nutrition?
Hope you can answer me.

Answer
In the evenings it is often the most difficult moment of the day, because you have also sat down for a day, and you have to cook, want some rest ... What I read in your story, is recognizable. It falls within the "normal" behavior of your baby. Your breastfeeding is fine. You write that she grows well on it. That's nice, she gets enough nutrition! And your food is of superior quality! The fact that she is uneasy after 18 to 23 hours after feeding can be related to the need to drink more often with you from comfort, comfort, sucking need, saturation, nightcap, processing the impressions of the day, suffering from some cramps, the sleep can not really grasp, but still be tired, etc. Constructing to meet that need is fine !!
She will love that. And if it's too painful, then giving milked milk will meet that need to a certain extent. You can also do the bath, or take a walk, or carry around, (in, for instance, a sling or a bag) or just keep it nice, cradles comfort.
Just for the sake of clarity: enough nutrition can be seen on 3 important pillars: weight gain (minus 140 g per week) 4 heavy plasluiers per day and an alert baby when awake.
What (often) does not work: expect the baby to be in the same sleep-wake rhythm as during the day, and still try to put her in bed with unrest and howling.

Our child is now 3 weeks and 3 days old, I also give breastfeeding and flask. How many cc can she have?

Answer
The number of cc's is not so much dependent on age. However, her need, and the weight can also give an indication (we use the calculation for: 150 times the number of kilograms she weighs per 24 hours. Share by number of feedings and you get the number of cc's you can offer in the bottle.) But her need is much more determined. Try 100 cc, see what she drinks from it. one time she will want more than the other time. that is normal.

My nipple is somewhat crooked. What now?

Answer
It is a very short question. Do you breastfeed? Are you pregnant? Does your nipple always have that shape? Is it on both sides? In general, you do not have to worry about the shape of your nipple. I do not expect any problems with careful laying of your baby. But I say this purely in its algm unit, because I do not see anything now. Otherwise, make an appointment with a lactation consultant in your area if you still want further research.

I have been breastfeeding since the birth of my daughter. But after the first 4 days, it turned out she did not have enough on the chest and that she always kept losing weight. The maternity nurse advised me to poke. What I still do, by the way. And from the 8th day I was also advised to give my baby Nutrilon in combination with breastfeeding.
Now my child is 3 weeks and I give her about 3 to 4 bottles of milk per day. The rest is breastfeeding (or fibrous milk).
It is clear that I do not produce enough milk because I notice myself that my daughter is still hungry when I only give the breast.
Since my situation I have three questions:
- is that that frying stimulates the production of breast milk?
- how can I increase my milk production?
- if in a few weeks I do not have enough milk to feed my child, what can I do best?

Answer
Your question is not 1-2-3 to answer. I will explain to you why and answer as good as possible. The problem lies in the cause of the too low production. If you know why you make too little milk, you can then do something about it. In your case it is a pity that you did not have a lactation consultant on that fourth day or in the days after ... but that was easily said afterwards. Then it could be determined why the production was left behind. The delivery can have an effect, the first hours after, the laying in that first week, the entire nutrition policy and your condition. How is it erupted, (how often, how long, how much applied, how much skin on skin contact, etc.) milk production starts under the influence of the hormone prolactin. This hormone remains active if only enough is applied and if there are no limiting factors present (which I can not now verify). Flasks can stimulate production, but this does not happen with every woman in the same way. There are mothers who flap with difficulty and production is lagging behind and there are also mothers with overstimulation. This also depends on the way of flasks, the flask itself, and how it started. In short: there are big differences. You tell me that you have also started supplying artificial nutrition. therefore your baby will drink less from the breast.
You can increase your milk production by often placing your baby, feeding it and feeding it slowly when it grows well. this process is called relaction. I can not guarantee that you will be able to breastfeed completely, but it is worth trying! it is best to seek guidance from a lactation consultant in the neighborhood. Look at the NVL's descent, or if you live in South Holland, you can make an appointment with me. Then an answer to your last question: every drop of breast milk is 1! So then you continue to give a combination of breastfeeding and artificial nutrition. Everything you give aaan breast milk is included. Strength!

My baby suffers from cramps but still constantly asks for food. May this continue to give or does he get even more bothered by cramps?

Answer
Dear Eva, before I answer, how old is your baby? And do you mean to constantly ask for food, that he always wants to have the breast?
I therefore just take an assumption: he is the 1 and 3 months old and gets full BV. Is he growing well? (about 140 grams per week?) he pees enough (about 240 grams of fluid to diapers per day) How does a diet run? (greedy, especially the first quantity?) This I ask because this can have to do with the cramps, and you can, for example, by another attitude, insert breaks, to 1 breast, possibly forkelk what uitkolven etc, what to do. If the cramps still remain, you can offer comfort by means of heat massage wraps, walking around, sucking.That sucking can be on the last given breast, then often does not come out so much, and as this is the greasy back milk, that saturates a little, and perhaps he becomes somewhat drowsy. An alternative is sucking on a finger (if, for example, he starts to take in all the waves again, because that will cause him trouble again).

Our daughter is currently three weeks old. When she was born she did not want to drink at the breast. This resulted in a fight and she was angry with her chest. We then tried cupfeeding and fingerfeeding. After a few days of help, she took the breast with a nipple hat. After that she always wanted the bottle. I myself had the idea that she does not really swallow the chest, suck it (a few times and then she stops again). Last week I tried a different attitude, the rugby position. I notice that she swallows in this position. She just does not always want to take the breast. Then she is angry and she pushes the chest away. It does not work when we have calmed her down. She will then receive a bottle. At the moment it is about alternating with feeding, so one time and then a bottle and the other time a bottle with breastfeeding. I wonder how we can get our daughter to sink into the breast and not be so angry. I myself have the idea that the hair does not go fast enough and that she will let go after bite. Are there any tips in this situation?
Furthermore, I had 1 very hard chest last weekend. I myself think that it was stowing, but the strange thing is that I could pump less, before I fired 70 cc, now only 30/40 cc from that breast. Is there something I can do so that the production in that breast rises again?
I hope you can give me tips and advice.

Answer
I apologize for this late response. The mail has not come through, I fear, now when answering another question I suddenly see him. A reaction will be very dated ... I hope you have found your way to another lactation consultant. To still go into your question: Yes indeed she finds a bottle faster than the breast and she will protest when the chest slows down. With a nipple hat she also has to make extra effort. Tip is another bottle that goes slower, such as calma. give as little bottle as possible and continue to try. Hard breast can be caused by using the nipple or not properly emptying the chest. The stowage that then arises, as it were, locks the chest (hidden) and therefore you also fatter less. Warm well in advance, let it drink well / flasks (and without teat hat ...) and cool afterwards. what you call all is an indication in itself for someone to watch. But you are probably already in another phase, so if you still have a current problem then you can still try it through the site.

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