Does my baby need Vitamin D?

Vitamin D for babies

Vitamin D supplements in breastfed babies

I had no idea that I should be giving my baby vitamin D until I saw my niece being given vitamin drops by her Mum. By this time, Mr J was 5 months old and I felt incredibly guilty that I’d somehow missed this nugget of information. I was under the  impression that, because I was breastfeeding and taking vitamins myself, baby ones weren’t necessary. Despite all the health visitor, midwife and weigh-in clinic appointments, not one health professional had mentioned this to me, and I couldn’t for the life of me remember reading it anywhere.

When I was pregnant I dutifully took my 10 micrograms (µg) of vitamin D every day. I carried on taking the recommended supplements when I started breastfeeding, but it seems I’m not alone in missing the advice about supplements for your breastfed baby. Vitamin brand Nutrimum say that in a survey of 250 pregnant and breastfeeding women across the UK, less than a third were aware of the role of vitamin D in pregnancy and breastfeeding. A US survey also found that of 184 breastfeeding women, only 55% gave their babies vitamin D supplements.

The science bit

Pregnant women in the UK are advised to take vitamin D supplements throughout pregnancy. It was previously thought that the vitamin D taken by a mum in pregnancy, plus the amount passed on in breast milk, would provide her baby with sufficient vitamin D. However, this recommendation changed in July 2016 when evidence in a government report found that an exclusively breastfed baby was unlikely to maintain adequate levels for the first 6 months of life.  The current NHS advice is that breastfed babies from birth up to 1 year of age should be given a daily supplement containing 8.5 to 10 µg of vitamin D. This applies whether or not mum is taking a vitamin D supplement herself. Formula milk is enriched with vitamin D, meaning that formula-fed babies should get what they need as long as they have at least 500 ml a day of formula milk.

It’s really important to understand that if you’re breastfeeding, your breast milk is enough for your baby. The concern over vitamin D comes from the fact that, in the UK, we all have relatively low exposure to sunlight which is needed to activate vitamin D in the body. In fact, the Department of Health say that, because vitamin D is quite hard to get from food alone, everyone in the UK should consider taking a vitamin D supplement over the winter months. Vitamin D is essential for bone and teeth health, and deficiency in babies can lead to complications such as rickets, delayed tooth eruption, increased risk of infection, decreased bone mass, hypocalcaemic seizures, and delay in walking.

benefits of breastfeeding

Which vitamins should I use?

Healthy Start vitamins are available in some areas of the UK to pregnant and breastfeeding women. However, my own experience has been that these are poorly publicised and can be hard to get hold of. Other mum friends have told me that they thought they were only for low income families, and access does seem to vary by region. The drops currently contain 7.5 µg vitamin D in a daily dose, but this will increase to the recommended 8.5 µg in a new formulation available from September 2018.

It’s worth asking staff at your local children’s centre or baby clinic if Healthy Start vitamins are available, as these are free of charge. If you’re in England you can use this search function to find the closest place that gives them out. If you can’t access these, look for a multivitamin that contains the recommended 8.5 – 10 µg of Vitamin D in a daily dose.  Check the packaging to see how much you need to give, as the volume varies between brands from 0.3 ml to 2.5 ml. This might not sound like a big difference, but once your baby knows what’s coming and has the ability to dodge the spoon or dropper, it’s far easier to give a smaller dose!

Why are my nipples stretchy?

Breastfeeding a newborn

Elastic nipples during breastfeeding

If you’re breastfeeding you’ve probably noticed that your nipples have taken on a new super-elastic property. This will be especially obvious when your baby does a sudden detach from the breast, or when they decide to have a look around with your nipple still in their mouth, leaving you wincing but also wondering if you missed a career opportunity as a contortionist. Something about the sound of milk being frothed in a cafe is guaranteed to turn Mr J’s head: cue Stretch Armstrong nipple and public boob exposure.

The science bit

Protractile (stretchy) nipples are caused by hormonal changes that start during pregnancy and continue during breastfeeding to promote skin elasticity. Around 1 in 10 pregnant women have flat, inverted or non-protractile (less stretchy) nipples. Because none of us are perfectly symmetrical, including our breasts, this may affect one or both sides.

For over 50 years in the UK, and elsewhere, it was common practice to assess pregnant women’s nipples. Women with anticipated problems were advised to “prepare” their breasts by one of two methods. Either wearing breast shells (a kind of dome that fits over the nipple and part of the breast and is worn inside the bra to gradually stretch and elongate the nipple), or doing Hoffman’s exercises, which involve stretching the nipples with your fingers and thumb . This practice was based on little evidence, and often had the unfortunate effect of undermining a woman’s confidence in her ability to breastfeed before she had even started. A study conducted in Southampton in the late ’80s found that using shells actually lowered breastfeeding success rates, and the nipple stretching exercises had no effect.

Some mums might doubt their ability to feed because of the way one or both nipples look. However, a visual assessment in pregnancy doesn’t really give much information away, as nipples can appear flat or inverted but actually protrude when the baby starts feeding. In fact, NICE (National Institute for Health and Care Excellence; the body who decide which treatments and drugs should be offered to patients through the NHS) state in their antenatal guidelines that routine breast examination to promote breastfeeding is not recommended. The best test is how well the baby latches and feeds once they arrive. Remember that babies don’t nipple-feed, they breastfeed. The nipple plus breast tissue are drawn into the shape of a teat in the baby’s mouth, and nipple elasticity helps with this.

What if I think my nipples aren’t stretchy enough?

La Leche League GB has some really practical advice on feeding with inverted nipples. Nipple elasticity often improves over time as the baby latches and sucks over successive feeds. However, when feeding isn’t going well in the early days it can be really disheartening, not to mention painful. My advice would be to attend a breastfeeding clinic (these are usually found at hospitals or children’s centres – a midwife or health visitor should be able to tell you about your local one) or, better still, arrange for a lactation consultant to visit you. The IBCLC website is the best place to look, as all of the consultants listed are professionally qualified. They will sit with you while you feed and offer one-on-one advice. Every breastfeeding partnership is unique to mum and baby, so this practical support can make all the difference.

I had a lactation consultant visit me at home when Mr J was a few days old as I was struggling with latching and positioning. Actually, struggling is an understatement. I couldn’t get him to open his mouth wide enough, and when he did I was too slow and unsure to actually get him on the breast. I was so stressed about it that I was gripping his poor little neck, which meant he couldn’t tilt his head back to get a deep enough latch, and oh how it hurt.  If I hadn’t had that support early on, it could have spelt the end of our breastfeeding journey.

Some consultants work on a voluntary basis, others charge a nominal fee. I paid £50, but the consultant stayed with us for over 2 hours and followed up with phone calls and texts over the next few weeks to see how I was getting on. She gave me confidence, and it was worth every penny!

Pregnancy acne: It’s not all glowing

pregnancy photography

Is the pregnancy glow real?

Ah, the pregnancy glow. Holy grail of all three trimesters. Well-intentioned people feel obliged to say you have it, even when you clearly don’t. Or maybe it’s just a perma-sheen of sweat from fighting back waves of nausea.

It can feel as if there’s a societal pressure when pregnant to be emanating a fertility goddess-like glow, perhaps so that people can compliment you without stepping onto the dodgy turf of commenting on your size. However, there are many pregnancy symptoms that can leave us feeling less than glowing, and if you are one of those women who suffer flare-ups of acne in pregnancy (myself included) it can really knock your confidence.

The science bit

Depending on which source you look at, more than 2 out of 5 women will suffer from acne during pregnancy, and it’s especially common in the first trimester. You’re more likely to suffer from acne in pregnancy if you already have a history of it. Although some healthcare professionals may dismiss acne as a cosmetic complaint, it can have a massive impact on a woman’s quality of life and can even put the sufferer at greater risk of depression.

Hormonal changes in pregnancy lead to increased activity in the oil-producing glands in your skin. There are more of these glands present in the skin on the face than other parts of the body.

But what is the point of having more oil in your skin? Well, increased sebaceous (oil gland) activity encourages the development of Montgomery tubercles in the breast. These are pimple-like bumps on the areola that provide lubrication to the nipple during breastfeeding. This increased oil production, and the higher volume of circulating blood during pregnancy, probably contribute to the famous pregnancy glow.

What can I do about my pregnancy acne?

There are many prescription treatments available for sufferers of acne, both oral (tablet form) and topical (applied to the skin). However, not all of these are safe to use in pregnancy. If you are already using prescription medication and trying to conceive or think you might be pregnant, it’s really important that you consult your GP or dermatologist straight away. Topical retinoids and certain types of antibiotics aren’t suitable for use in pregnancy because of a risk of harm to the developing baby. Fortunately, there are still some medicines that can be taken during pregnancy. If your acne is bothering you and shop-bought skincare remedies aren’t working, make an appointment to see your doctor and talk to them about how it’s making you feel. Your GP should discuss the treatment options available to you while pregnant and weigh up the possible risks and benefits. Be prepared that if you’re in your first trimester it may be a waiting game, as many women find that their skin settles down later on in pregnancy with no treatment necessary.

skincare for acne in pregnancy

In any case, many women prefer not to take any drugs in pregnancy unless they really need to, so here are some options to consider trying first.  I highly recommend La Roche Posay’s Effaclar range for acne-prone skin (during pregnancy and beyond!). The problem with many high street skincare products for spots is that they work by drying out the affected area. This often has the opposite desired effect of making the blemish more obvious because it also dries the skin around the spot. The Effaclar range uses anti-inflammatory and hydrating ingredients and is gentle on sensitive skin. The Effaclar Duo+ Unifiant moisturiser comes in two shades (as well as a non-tinted version) so you can use it instead of foundation. It can be applied easily with fingertips or a make-up brush/sponge and is buildable, so you can achieve fuller coverage, or just go for a dewy, fresh look. It’s so quick to use that it’s now become my go-to base since having a baby, as I find primer, foundation and blending way too much effort!

A French study found that acne in pregnancy was more likely to affect the back than acne in non-pregnant women. I discovered the Serozinc Toner Mist spray in the lead-up to my wedding as I was wearing a backless dress and was terrified of a breakout with that area being on full display. I started using it again on my back and chest when pregnant, and found that it helped to heal old blemishes and keep new ones at bay.

And a final word, be careful which stretch mark lotions you use or which part of the body you use them on. Some contain shea butter which, whilst being a lovely rich moisturiser, is comodogenic meaning that it blocks pores. Blocked pores can also lead to spots so if you’re using a shea butter-based stretch mark remedy, avoid putting it on your upper torso if you’re prone to spots on your back and chest and wash your hands after applying to avoid transferring any to your face by mistake.

pregnancy skincare

As for the pregnancy glow, don’t worry if it never comes. You will glow with hormonal pride when your baby arrives.

M&S breastfeeding friendly swimsuit review

Zip front M&S swimsuit

Swimwear you can breastfeed in

This morning’s swimming class was a chance to try out my new Marks & Spencer swimsuit. The zip is functional, so it’s a doddle to breastfeed in and it has built in tummy control so it’s a bit more flattering. I love the print and it definitely screams summer.

Zip front M&S swimming costume

It’s pretty reasonably priced at £29.50 and comes in sizes 8 – 22 (I’m wearing a size 8 here and I’d say it’s pretty true to size). The fabric is soft and stretchy so it feels comfortable, with no annoying bits digging in! Mr J is wearing a John Lewis SunPro swimsuit with built in UV protection.

I ordered online and collected in store as it drives me nuts when my size isn’t available. So get ordering mamas. Perfect for feeding by the pool or on the beach!

Normalize breastfeeding

What drugs can I take while breastfeeding?

How to check what medicines are safe to use while breastfeeding

How many of us suffered through colds and hayfever while pregnant with only feeble hot lemon and honey drinks for relief? Oh, how I longed for decongestants and antihistamines! If you were to read Patient Information Leaflets (“PILs”, aka the little bits of white paper inside medicine boxes), you’d be forgiven for thinking the situation with taking medicines while breastfeeding isn’t much better.  However, the wonderful people over at the Breastfeeding Network have compiled a number of fact sheets summarising the available safety information on a whole range of different types of prescription and over-the-counter drugs so that breastfeeding mums can make informed choices about what they take. They also run a Facebook page and email information service in case a drug you wish to take isn’t covered in their factsheets, or if you just need a bit more advice.

The science bit

So why do drug manufacturers recommend against the use of so many medicines while breastfeeding? The answer is simply lack of conclusive evidence. Virtually all clinical trials exclude pregnant or breastfeeding women because of the ethical and legal implications if something were to go wrong. If you asked a pharmacist or GP if a medicine was ok to take while breastfeeding, they’d probably recommend against many of them because the textbook they refer to (the British National Formulary or BNF) usually provides little guidance. However, there is often additional information available from pharmacokinetic and pharmacodynamic studies, which can tell us how much of a drug passes through to the mother’s milk, for example. Small trials and case reports of breastfeeding women who’ve taken medicines sometimes also add to the body of evidence.

So how do I know which drugs are safe?

Your GP should always be your first port of call for any prescription medicines. However, if they are recommending against you taking something that you feel you really need, it’s worth checking the Breastfeeding Network’s information sheets. Print one off and take it to the GP with you if necessary. They cover everything from antidepressants to migraine medication.

For over-the-counter medicines, it is definitely worth checking the factsheets before completely discounting taking something. For example, I am currently suffering with hayfever (and also breastfeeding), but all the available over-the-counter medicines are not recommended by the manufacturer. However, when I checked the relevant information sheet from the Breastfeeding Network I can see that certain types of hayfever tablets reach low levels in milk and therefore should be ok for me to take.  This is, of course, my decision based on what I have read, and what I feel are the relative risks of taking the medicine versus the benefits of me getting some relief!

Needing to take medication should never be a barrier to you continuing your breastfeeding journey. So arm yourself with knowledge and make the decision that’s right for you. Good luck mamas!

Keeping your baby or toddler safe in the sun

Staying safe in the sun

How to protect your little one from the damaging effects of the sun

Yes! Summer is officially here in the UK. Ditch those winter jumpers and stockpile Mars Bar ice creams before the freezer section of Asda is decimated. If, like me, you found yourself using your head as a human sun shield while pushing your little one around today, you will intuitively already be protecting your baby from direct sunlight. But the problem with the mum head eclipse technique is that the sun moves, and so do you! So what more can you do to keep your baby safe?

The science bit

It’s common sense that babies and children have more delicate, sensitive skin that can burn more easily. There is also evidence showing that exposure of newborn skin to UV radiation from the sun can cause changes in skin cells that persist into adulthood, and which could play a role in the development of skin cancer.

Protecting your baby from the sun

 

Top sun safety tips for babies and children

  1. Seek out shade

    Yes, it’s obvious. But if you’re used to staring out your office window thinking, “Why is the best weather reserved for work days”, you’ll have an urge to soak up those rays. So ignore the urge and find play spots under trees, walk on the shady side of the road, sit under a parasol. The NHS recommends keeping babies under 6 months completely out of direct sunlight, but especially around midday (I would go further and say avoid exposure between 11am and 3pm).

  2. Dress for summer

    This is the fun bit, right? Cute summer rompers worthy of Prince George. Of course we want to keep our little ones cool and protect their heads, but don’t forget to cover the other parts of the body that will see the most sun. For toddlers on the move, that means shoulders and the back of the neck. T shirts with short sleeves are far better than strappy tops, and hats with a neck flap or a soft brim that you can pull down at the back are better than baseball caps. Check out British brand Toby Tiger for some gorgeous bucket-style sunhats, and organic kids clothing company Frugi for hats with neck flaps that can be worn in the water.

  3. Get a Snoozeshade

    This is a great invention, and best of all it was designed by a fellow sun-dodging mum. It fits over any pushchair in either the bassinet or upright formation, and blocks out 80% of UV while still allowing your little one to see out. The breathable cover is super easy to fit and, because it folds down into a tiny little drawstring bag, I keep mine with my buggy at all times alongside my rain cover (it’s England, land of snow in March and 25°C in April). It also creates a nice dim environment for naps on the go and keeps all nature of flying pests away from your little munchkin. A UV cover or parasol specifically designed for the job is far better than a loose muslin over your pushchair, as they allow for ventilation and block the harmful UV rays.

  4. Slap on the suncream

    Most sunscreen isn’t suitable for babies under 6 months, hence the advice to keep them completely out of direct sunlight. There are, however, a couple of brands that have been specifically formulated for babies under 6 months. Mustela and La Roche Posay both offer sunscreens that are suitable for newborns and are also good options for children with eczema or very sensitive skin.
    For older children there are a whole host of options available. A sunscreen specifically designed for children is best, as the chemicals in adult creams are too strong for their sensitive skin (adult sunscreens absorb and dissipate UV radiation, whereas children’s suncreens use minerals to reflect it). Apply thickly 30 minutes before going outside and reapply every two hours as a minimum.

    Here are the key things you’re looking for:
    – SPF of 15 or above
    – UVA and UVB protection (a UVA rating of 4 stars or higher if you’re going abroad)
    – Maximum of 1 year since opening – if it’s from last year, bin it. My top mum hack is to use a permanent marker to write the date you opened it directly onto the bottle
    – Waterproof if you’re heading to the beach or pool

  5. Hydration, hydration, hydration

    If you’re breastfeeding, be prepared that your little one may want to feed more often than usual to hydrate themselves. It’s therefore really important that you also stay hydrated. I love this bottle from the Breastfeeding Network . If you’re formula feeding, you can give your baby cooled boiled water throughout the day on top of their normal bottle feeds. If your little one is over 6 months old and they get bored with water, try a few covert techniques to get water into them. Ice cubes or homemade fruit lollies can be popular, or fruit and veg that’s high in water content such as melon and cucumber. I’ve found that Mr J loves sucking water out of a flannel – usually bathwater but that’s not advisable!