Melanie Cole, MS (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels. Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And joining me today is Dr. Elizabeth Odom. She's an Assistant Attending Pediatrician at New York Presbyterian Hospital, Weill Cornell Medical Center, and an instructor in Pediatrics at Weill Cornell Medical College, Cornell University, and she's also a certified lactation counselor. And today, she's going to tell us all about breastfeeding.

Melanie Cole, MS: Dr. Odom, it's such a pleasure to have you with us today. I'd like you to start for new expectant parents about the health benefits of breastfeeding and what that gives baby and the mother.

Dr Elizabeth Odoom: Oh, my goodness, where to begin? So, the benefits to babies really are limitless. We see decreased rates of infections, like ear infections, respiratory infections, and diarrheal illnesses. We see decreased risk of SIDS. Children have lower rates of asthma, eczema, celiac disease, Crohn's and ulcerative colitis. There's less obesity and diabetes. And breastfed babies even have lower rates of leukemia. So many wonderful health benefits to babies.

And I love that you asked about moms too, because I think sometimes we forget about moms who are really doing a lot of hard work with this. And in addition to all the bonding that everyone talks about, moms have decreased risks of diabetes and high blood pressure, as well as decreased risks of breasts and ovarian cancers when they breastfeed.

Melanie Cole, MS: So many benefits, Dr. Odom. Tell us what is a lactation counselor. As I said that in your title, what does that mean?

Dr Elizabeth Odoom: So, there's multiple ways to become certified in lactation counseling. There are two big ones that most people see and one is being a CLC, which is what I am, that's a certified lactation counselor. And the other one is an IBCLC, which is an international board-certified lactation consultant. They have slightly different pathways to getting your certification. But either way, the person who's certified as a lactation counselor has gone through multiple classes, hands-on experience and taken certification tests on the topics of lactation and breastfeeding in order to get their certification.

Melanie Cole, MS: Wow, that's quite extensive. So, tell us a little bit about newborns. What is colostrum? How does it help the baby? Tell us about normal breast milk production from colostrum to mature milk, and how can you tell when your milk's going to come in.

Dr Elizabeth Odoom: So, colostrum is the very first milk that we produce. And oftentimes, we call it liquid gold. So, it's produced by pregnancy hormones and some moms will even notice leakage in their second and third trimesters of pregnancy because they've started to produce colostrum. Colostrum is super high in protein, vitamins and minerals, and it's also chock-full of antibodies, which help to protect the baby from infection. It's more yellow in color than regular breast milk. So, we give it that gold name, not just because it's so valuable, but also because of its color. We tend to see that that's what the baby's eating over the first few days of life.

Generally, moms won't have major breast changes when they're producing colostrum because colostrum comes out in such tiny amounts. After the baby's delivered, the placenta separates from the uterus and this stimulates the body to say, "Okay, we've started producing colostrum, but we're going to need to ramp up and produce mature milk because that's what the baby's going to need." And there's a huge shift in hormones at this point in time. And the body will start to make that transition. And typically, that transition happens between two and four days of life. And that's when that colostrum starts to change into mature breast milk. And normally, that milk starts to change from that yellow color where it's like yellow and super thick into more of like a thinner whiter color. Moms will start to feel breast changes. So, they'll feel an increase in their breast size, their breasts will feel more full and firm. And these are all signs that the milk is transitioning to mature milk.

I think one thing that is important to know is that first time moms and moms who have C-section are prone to delays in a transition to mature milk. So, we always keep that in mind when we're talking about when your milk has come in, knowing that you're a first time mom or you've had a C-section, it can be a few more days than that two to four-day period.

Melanie Cole, MS: Well, thank you for that. So, Dr. Odom, I think we just have to ask this question because not everybody can nurse their babies. I'd like you to speak about how breastfeeding compares to formula feeding. And obviously, when formula was in vogue, we didn't want to shame breastfeeding women and vice versa now, we certainly want to let women know if they're having trouble, they can talk to their pediatrician, to their obstetrician gynecologist. But tell us how these two things compare.

Dr Elizabeth Odoom: So at the end of the day, I really want to stress that a fed baby is the best type of baby. And whether or not that is breast milk or formula, I am really happy with either, as long as that baby is fed and growing and healthy. That's really the most important thing that we can do for these babies. And if a mom isn't interested in breastfeeding, that's also completely okay. Plenty of formula-fed babies are absolutely wonderful, brilliant, healthy people.

When we talk about sort of the comparing of breastfeeding and formula, we've already talked about all of the great benefits in terms of like health benefits of breast milk. I think the other great benefit of breastfeeding is that it's free, it's portable, it's natural. You don't have to mix bottles and clean lots of supplies, and it's a really nice bonding experience. The one thing to know about breast milk though, it is low in vitamin D. So whereas babies who receive formula don't need any additional supplements, breastfeeding babies will need to actually get a vitamin D supplement every day.

Melanie Cole, MS: That's interesting. And absolutely, cost is certainly an important issue. Now, how long is it recommended that women breastfeed. And I'd like you to speak about some of those newborn feeding patterns as they go through that first year.

Dr Elizabeth Odoom: So in terms of recommendations for breastfeeding, the AAP, which is the American Academy of Pediatrics, the CDC and the WHO all recommend exclusive breastfeeding for the first six months of life. After which, families will start to introduce complementary foods. The CDC recommends parents plan to try to do breastfeeding for the first year of life, whereas the AAP and the WHO actually recommend continuing for two years or beyond. At the end of the day, I recommend that moms breastfeed for however long they want to, and they're able to. Because a parent who's doing whatever is best for themselves is a parent who's doing what's best for their baby.

In terms of talking about newborn feeding patterns, newborns feed about eight to 12 times a day. So, that's approximately every two to three hours. And we count from the beginning of one feeding to the beginning of another, which is hard because it doesn't really mean that you're getting two to three hours off between each feeding session. So, they're feeding very frequently. We often recommend that you look for those hunger cues in a baby. So, crying is a pretty late hunger cue. That means that the baby is really hungry. So, you're going to want to look for some of the earlier hunger cues to start that feeding. And those hunger cues can be licking and smacking the lips, sticking the tongue out; rooting, which is where you see sort of them turning their head and their chin side to side; and putting their hands to their mouth, and those are all signs that your baby is starting to get hungry.

Melanie Cole, MS: And those are all the cutest little signs. Boy, I just love the babies so much. So, how can the whole family, especially the partner, get involved in the feeding process when a woman is breastfeeding?

Dr Elizabeth Odoom: It can be really hard for family members and partners to feel involved when a woman is breastfeeding. But I want to stress that there are so many ways to take care of a baby outside of feeding. So, bringing a baby to mom when it's time to breastfeed, helping with the burping, helping with the diaper changes, these are all really important tasks. And also, taking care of that breastfeeding partner. It's really hard and exhausting to breastfeed. So for her to have supports in a partner, such an important task and such a really great way to be involved and help.

Melanie Cole, MS: It certainly is, and it's such a lovely time of life. It really is. Now, some women have difficulties at first. As a certified lactation counselor, tell us about how latching baby onto breast and difficulties women may encounter when they first start, and some solutions tips you give women every day.

Dr Elizabeth Odoom: Latching is really hard, and I can't stress that enough. Breastfeeding is not necessarily intuitive and it's a learning process for both the parent and the baby. And we spend a lot of time in the first few days of breastfeeding trying to figure out how to get that latch. Oftentimes in the first day, that latch is suboptimal, and it causes a lot of nipple pain, which makes continuing to work on that latch and breastfeeding really difficult. So, we work really hard on that latch in the very beginning to try to decrease that pain and get into sort of a good breastfeeding routine. We sort of touched on this earlier, but I think it's really important to make sure that your baby is not crying and ravenous when it's time to feed, because they're going to have a much more difficult time latching and it's going to become a lot more stressful both for the parent and the baby.

So when we're getting ready to start that latch, I really recommend looking for those early hunger cues and then starting with a little bit of skin to skin time that lets your baby listen to your heartbeat, which is soothing for the baby. It lets them smell you and feel that comforting smell because their sense of smell is way better than ours. And once we've done a little skin to skin time, that's when we're going to bring the baby to the breast. And we're going to let the baby sit there for a minute. We're going to let them smell the nipple and smell the milk. Sometimes we can even hand express a single drop of milk onto the nipple before the baby latches, because that will heighten their sense of smell and get them ready to feed.

And I think the biggest latching problem that I see is that oftentimes people feel that they want to line up the baby's mouth with the nipple, which makes sense to most people. Obviously, that's how the baby's gonna feed. But that will not let us get a really deep latch. So, what I actually recommend is starting with the baby's nose lining up with the nipple. The baby's going to smell that breast milk and they're going to open their mouth really wide because they're all excited to feed, and that's when we're going to latch. And because we started with the nipple lined up with the nose, the nipple is going to end up going into the top part of the baby's mouth, which allows for a deeper latch. And that reduces nipple trauma and it allows for better milk transfer. So, that would be my biggest tip for moms when they're trying to do that latch initially, it can make a world of difference.

Melanie Cole, MS: What an incredible explanation that was. And women, listen to that again. And if you're having trouble, that's exactly the kind of tips that we're giving here on Kids Health Cast. That was excellent, Dr. Odom.

So, I'd like you to speak about women themselves, their nutrition, any medications that they're on. What would you like women to know that while they're nursing for whether it's six months, a year, or longer, what they should be doing for themselves as far as nutrition and taking care of themselves?

Dr Elizabeth Odoom: So important to make sure that you are taking care of yourself, and I say this to all first time moms, regardless of if you're nursing or not. But especially if you're nursing, you're working really hard to produce breast milk every few hours all day long. So, it's really important to be eating well-rounded meals and to be hydrating. Hydrate, hydrate, hydrate as much as you possibly can.

Medication-wise, people will often ask a lot about supplements that they can use to try to boost their milk supply. All of those things, those lactation cookies, those oats, those brewer's yeast and fenugreek, and all the things you can read online have not actually been shown to help or make any sort of difference in boosting milk supply. So, I'd say the most important thing is that you're taking care of yourself and you're doing as much breastfeeding on demand, because that's really what makes a difference in milk supply.

Melanie Cole, MS: And by medications, I just want you to clarify too, some women are on high blood pressure medication or diabetes medication or something else. Can they take those while they are breastfeeding?

Dr Elizabeth Odoom: So many medications we can take while we're breastfeeding. There are a few out there that we can't, so I really recommend that you talk to your doctor about this. Some doctors don't necessarily know whether or not that medicine is safe for breastfeeding. And so if your doctor's unsure, please, please ask around and pursue it further. Definitely ask your pediatrician or a lactation counselor. There are wonderful databases out there. I personally use one called LactMed, where they look at every medicine and how that transfers into breast milk. And so, we can easily look these things up for you so that we can make sure that you are able to take a medication that's important for you and that it's safe for the baby.

Melanie Cole, MS: What great information. I just would like you to wrap it up, this has been so informative, Dr. Odom, with your best advice for new parents, expectant parents and some are a little bit nervous about that first couple of months with new baby and breastfeeding. What do you tell women every single day?

Dr Elizabeth Odoom: It can be really easy to feel alone right after you've given birth and you're trying to breastfeed and you're exhausted and you're stressed. So, I think the most important thing I can recommend is talk to people. Lean on your support system, your pediatrician, your obstetrician, a lactation counselor, family and friends, like we are all here to support you in whatever you want to do. I think whatever you decide to do is what's going to be best for your baby, and we're just here to support you and help you through that.

Melanie Cole, MS: Well, you certainly are. And thank you so much, Dr. Odom, for such great advice and excellent information. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcasts, Spotify, and Google Podcasts. And for more health tips, go to weillcornell.org search podcasts. And don't forget to check out our Back to Health series, so many great podcasts there. I'm Melanie Cole. Thanks so much for joining us.

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