5 Breastfeeding Secrets Your Pediatrician Won’t Tell You

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I remember telling my pediatrician for the first time that we comfort nurse–even to sleep.

That’s perfect,” she said. “There’s nothing wrong with that.”

I was a new mom at the time, so I was nervous about how she would react. It was a relief to know that we were both on the same page about this and about breastfeeding generally. It’s one of the many reasons I love my ped.

Unfortunately, not all pediatricians are “breastfeeding-friendly.”

Most encourage it at least initially, but when difficulties arise, research has shown that pediatricians today are less likely to believe mothers can be successful breastfeeding and less likely to feel that breastfeeding difficulties are worth overcoming (source).

If your goal is to breastfeed, this is a problem.

Are you confident your pediatrician is breastfeeding-friendly? You may need to think again. Here are 5 breastfeeding secrets you pedi might not tell you.

Supporting a nursing mother is more than simply telling her breastfeeding is a good idea. It’s helping her find lactation help when the practice can’t provide it. And it’s supporting baby’s health in ways that don’t undermine mom’s breastfeeding goals whenever possible.

As a breastfeeding counselor and co-admin of a private Facebook support group of over 13,000, I too often see moms not getting basic breastfeeding information they need.

Here are 5 breastfeeding secrets you might not be hearing from your ped (keep scrolling, or download the cheat sheet below):

Does your pediATRICIAN actually support breastfeeding?

Discover these 5 secrets a breastfeeding-tolerant pediatrician won’t tell you. 

1) If breastfeeding is broken, a bottle won’t fix it

A bottle can be a useful tool to get baby fed while you get breastfeeding difficulties handled. It can be a useful tool for caregivers who need to feed baby when you cannot be there. It can be a useful tool if you would simply prefer to bottle-feed pumped milk or formula! There isn’t anything inherently wrong with bottles.

But if there is something amiss with baby’s latch or with your supply, and if your goal is to nurse off the breast, a bottle by itself is unlikely to be the answer to your troubles. In fact, it can actually make some issues worse!

If your pediatrician stops at suggesting a bottle, you will need to go elsewhere for help.

A qualified and experienced IBCLC (International Board Certified Lactation Consultant) will likely be better equipped to help you get to the root of your breastfeeding difficulties. Not only can they typically meet with you for a much longer period of time–an appointment usually lasts from 1 to 2 hours, often in the comfort of your own home–but their lactation training will also be more extensive.

The truth is, most pediatricians have limited–if any–lactation training and limited experience with clinical breastfeeding management (source, source).

A breastfeeding-friendly pediatrician will give you guidance on supplementing if needed while also encouraging you to see a lactation consultant. And a great breastfeeding-friendly pediatrician will have a list of referrals ready to go for you.

LEARN MORE: Worried about low supply? Get my FREE Low Milk Supply Cheat Sheet

2) This is how you protect your milk supply

Sometimes we need to supplement with pumped milk or formula per doctors orders, or we feel compelled to because we are afraid we aren’t making enough milk.

There’s nothing wrong with this. The first rule of breastfeeding is feed the baby!

If your goal is to breastfeed, supplementing just needs to be done carefully, because it adds variables that can affect milk supply. In some situations, it can even create supply issues that were never there to begin with!

The key to avoid accidentally causing a supply issue by supplementing is to make sure you pump every time baby receives a bottle.

Why? Because breastfeeding and pumping are what tell your body to make milk. Your body has no way of knowing it needs to make more milk if it doesn’t receive this signal, and it doesn’t get this signal when baby receives a bottle.

Avoid the top-up trap! This happens when you supplement formula or frozen breast milk. When baby get's a bottle, not only does he or she begin to prefer the fast, easy flow of the bottle resulting in breast refusal, but he or she is also not stimulating the breast. The body needs breast stimulation to know to make more milk. When it receives less stimulation because baby is drinking from a bottle instead, milk supply down regulates. And now you really do have a low supply issue!

When pumping for a missed feed, be sure to pump both breasts for at least 15 minutes–ideally closer to 20-25.

In most cases, you can supplement with your own pumped milk first and make up any difference with formula if needed. A breastfeeding-friendly pediatrician will encourage this whenever it is a viable option.

If your goal is to breastfeed and your pediatrician suggests supplementing with formula without mentioning the option of using your own pumped milk–either partially or in full–consider asking why. Supplementing with formula in lieu of available pumped milk is rarely medically necessary.

3) There is a better way to bottle feed

One large study of over 16,000 infants found that by age 5 months, bottle-fed babies consumed 71% more milk than their breastfed counterparts (source).

How is that possible? Do bottle-fed babies just happen to be 71% hungrier? I’m thinking probably not.

Instead, the difference is caused by how milk is released from the bottle compared to how it is released from the breast.

Bottle Vs. Breast: Not better, just different. The bottle has a firm nipple and an inflexible, fixed shape. Milk flow begins immediately, the flow is fast, and it requires fewer facial muscles to remove milk from a bottle. Bottles require shallower latches, and the tongue is positioned such that it is humped in the back of the mouth. Milk is released by gravity plus sucking that creates a vacuum. It is easy to overfeed from a bottle. In contrast, the breast ha a soft, flexible nipple that elongates in the baby's mouth. Milk flow is delayed until letdown, and flow is slow. It requires more facial muscles to remove milk from the breast, latch must be deeper, and the tongue must be cupped around the breast instead of at the back of the mouth. Milk is released by letdown and peristaltic tongue motions. It is difficult to overfeed from a bottle.

Bottles have a hole at the end. Turn it upside down, and milk will leak from it continuously. Bottles require fewer facial muscles, less effort to extract milk, and the faster flow makes it easier to eat quickly. Not to mention that until about 4 or 5 months of age, sucking is a reflex. And so is swallowing–it’s aptly called “the suck-swallow reflex.”

This means babies will automatically suck and swallow from a bottle, regardless of hunger. Babies can and do continue to drink from a bottle until they vomit or have no choice but to actively push the bottle away to be able to stop eating.

The breast, on the other hand, does not allow milk to continuously drip from the nipple (thankfully)! Only small amounts of milk are released until the “letdown” occurs (If you don’t feel your letdown, don’t worry–many women don’t feel it!) and milk flows faster for a few minutes before slowing down again. More vigorous sucking is required to trigger another letdown, while less vigorous sucking results in comparatively very little milk coming out (source).

In other words, the breastfed infant controls the feed, self-regulates milk intake, and can comfort suck without significant risk of overeating (source).

Bottle-fed infants, on the other hand, are more likely to be encouraged to finish bottles by a caregiver (source, source), can’t as easily control the rate of milk flow, and cannot comfort suck on a bottle without also consuming extra milk. As a result, they are at risk for

So what can be done about this? A little something called paced feeding.

Paced feeding helps bottle-fed babies self-regulate their milk intake by slowing down feeds. This is important regardless of the type of milk–breastmilk or formula–baby is drinking from the bottle (source).

Bottle-fed babies who are pace-fed tend to consume less milk while still receiving appropriate nutrition. And breastfed babies who receive pace-fed bottles on occasion are less likely to reject the breast and develop bottle preference (a.k.a. “nipple confusion“).

We know now that excessive milk intake in infancy is associated with an increased risk of obesity later in lfe (source). Unfortunately, many pediatricians either do not know the benefits of pace-feeding or don’t explain to parents how to do it. As a result, many babies are fed until they have to push the bottle away or until right before they would otherwise vomit.

A great breastfeeding-friendly pediatrician will share how to appropriately bottle-feed your breastfed baby. If yours didn’t, you can get a brief explanation here:

Want to know the secret to better bottle feeding?

Overfeeding from a bottle happens way more often than you’d think. Reduce childhood obesity risk with the tips in this cheat sheet.

4) There is no length of time your baby “should” go between feeds

Babies are not born with watches.

They don’t pay attention to how long it’s been since they were last at the breast.

And the idea that a baby “should” go a certain amount of time before nursing again is a cultural norm–not a biological one–that is based on bottle- and formula-feeding norms of the last century.

In our culture, as bottle-fed babies age, they are given larger and larger bottles so that they can go longer between feeds. This is for convenience, not because there is a biological reason a certain amount of time needs to pass.

Feeding schedules are convenient for parents, but they are NOT the way babies–especially breastfed babies–are wired to eat. Breast milk digests easily and quickly, and breastfed babies seek the breast for more reasons than just hunger!

In fact, there are MANY reasons a breastfed baby will desire the breast that have nothing to do with low supply or milk that “isn’t fatty enough.” Growth spurts, developmental leaps, relief from overstimulation and stress, and differences in milk storage capacity between mothers are just a few reasons why a baby might wish to nurse again before an arbitrarily amount of time has passed.

While the convenience of spacing out feeds is tempting, parents should be informed that for many, feeding schedules and taking steps to space out feeds can actually result in low milk supply (learn more here). Babies may naturally nurse less often as they age, and this baby-led regulation does not come with the same risk of low supply.

A breastfeeding-friendly pediatrician will not set limits on the number of times or length of time an otherwise healthy baby is allowed to nurse. He or she understands that feed length and frequency will be unique to each mother. It is normal for babies–especially young babies–to nurse 8-12+ times in 24 hours (source), and babies should be fed according to hunger cues (and from a pace-fed bottle when a bottle is needed).

If your pediatrician suggests that your otherwise healthy and growing baby should be going longer between feeds, or that your milk “isn’t fatty enough” or even “stops being nutritious” after a certain arbitrary age (usually 12 months), you may want to seek a second opinion.

IMPORTANT DISCLAIMER: If you are concerned that your baby is feeding excessively frequently, take your concerns to your healthcare provider and an IBCLC immediately. When a problem exists, it is usually accompanied by other symptoms that these providers can help you identify. If baby is not having an appropriate amount of wet and dirty diapers or shows signs of dehydration, inform your healthcare provider immediately.

5) You are not a pacifier

Perhaps this is merely a personal pet peeve, but I hear it so often from providers I feel compelled to address it:

Your baby is not “using” you as a pacifier.

On the contrary! Your baby “uses” a pacifier as a you! Pacifiers are a substitute for the breast, not the other way a round. They aren’t nipple shaped by accident!

There is nothing inherently problematic about a healthy, full-term baby suckling on the breast for comfort. It’s not any more inappropriate or problematic than suckling for comfort on a pacifier.

The only real difference? Cultural belief. Western cultures have a history of discouraging this natural way of soothing infants for reasons that have nothing to do with a baby’s biological well-being. We worry about creating “bad habits” to the point where we lose sight of the fact that comfort is a valid need.

You will not “spoil” your baby with too much affectionate access to the breast. You will not “create a problem” in the future, either–the “problem” of your baby desiring your close presence already exists! Likewise, you are unlikely to “break” breastfeeding by using a pacifier (source), and there is nothing wrong with feeling touched out or needing a break.

The truth is, the choice to comfort nurse or use a pacifier is yours to make. A breastfeeding friendly pediatrician will encourage you to make that choice as you see fit rather than push a culturally-biased, personal preference about the “type” of nursing you should or should not allow.

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LOVE,
GABBY

Additional References

  • Campbell, S. H. (2019). Core curriculum for interdisciplinary lactation care. Burlington, MA: Jones & Bartlett Learning.
  • Lauwers, J. (2016). Counseling The Nursing Mother: a lactation consultants guide. Burlington, MA: Jones & Bartlett Learning.
  • Wilson-Clay, B., & Hoover, K. (2017). The breastfeeding atlas. Manchaca, TX: LactNews Press.