Breast Feeding vs Formula Feeding

I made little plans for my little one while pregnant. I know, crazy, right? But I knew that every birth and every child would be different, and I had the basics down. The only plan I made was that I wanted to breastfeed. I have reviewed the evidence (and even the raw data – my graduate research project was on health outcomes of breastfed vs formula fed babies) and can tell you with complete certainty that whatever choice you make, your child will be healthy. Fed is best. Like with any two choices of any type, there are benefits and drawbacks to each. I wanted to breastfeed. I was a little weirded out by the idea of being basically milked and heard it can feel weird or painful. But, still, I had my plan.

When my daughter was born, I expected we would have to try a few times to figure it out. I had a visit from a lactation consultant, and followed her recommendations. However, my little one was not latching properly. And it was a slight latching issue, so I didn’t really recognize it. She screamed and frenzy fed and it was hard. It was also painful, and my nipples were bruised and even bled. Friends told me this was normal, and that breastfeeding just hurts at first.

When my milk came in, my breasts were red and hot and hard. I thought I was engorged or possibly had a blocked duct. It was painful and nothing seemed to relieve it. At one feeding, my daughter nursed for probably an hour. My breasts went down and I finally had some relief. Only they didn’t refill as much.

By the time we went in for our first pediatrician visit, she had lost a lot of weight. As the doctor talked about our feeding options, the baby bubble burst. You know, the bubble you get in when you first get that sweet, perfect newborn. All you can see is that perfection and you know you have the most beautiful baby ever born. And that new baby smell gets you. My baby bubble burst sitting in that office and suddenly I saw what I should have seen all along. Dry, cracked lips and dark circles under the eyes of my sweet baby. Her baby hands had brittle, easily broken nails. My baby was not getting nourished. And then the tears came. The doctor recommended supplementing with formula until we could get her weight up. She also recommended visits with the lactation consultant. She told me I was still a good mom and I could still achieve my goal of breastfeeding. All I could think was, “Fed is best. And my baby is starving.”

The lactation consultant was very helpful. Once we got her latched right and her belly full, nursing became a lot easier. Suddenly, that thing that was weird and painful at times became beautiful. I finally understood the enjoyment of nursing. However, this was not the end of our road. While nursing was easier, my supply was still lower than it needed to be. The lactation consultant recommended nursing for 10 minutes on each side, then supplementing with a bottle of breastmilk or formula, followed by 20 minutes of pumping. The goal was to build up supply and return to exclusively breastfeeding. This may not sound like much, but the whole process took about an hour. When your baby eats every three hours (even through the night), this takes up your entire day and night. I wasn’t eating or sleeping well. There was concern that my milk was affected by not taking care of myself.

I decided to let go of the idea that she would be exclusively breastfed. My husband agreed to take the first nighttime feeding and give her a bottle. This ensured I could get 5 or 6 hours of sleep instead of the 1-2 hours at a time of was getting. Sleep helped so much. I felt like my body was able to make more milk. I decreased the pumping time. I nursed her first, then supplemented with her “guaranteed calories” and only pumped when I felt like I needed it. Even at my peak of pumping, I was only getting around an ounce or a little more.

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One of my first pumping sessions. This is after 20 minutes of pumping. 

I wish I could tell you that was the end of our milky road. However, I got a nasty stomach bug when she was around 5 weeks old. It was terrible. The worst part was limiting my contact with the baby since I was contagious. I was too weak to pump. My supply dropped again. On top of that, she stopped latching well. She would nurse a little, break off, and cry. The bottle was a lot easier for her. Cue more tears.

I was also very hesitant to talk about it. I admit it, I did not want the judgement. I knew most people would not say mean things to my face. It would come in the form of well-intended, unsought after advice. Advice laced with a passive-aggressive agenda.

It seems I have spent her entire lift continually contemplating the breast vs formula decision. At the end of the day, the driving force for wanting to breastfeed was a little selfish. Nursing was our bonding time. In the first few weeks, there was a steady stream of family and friends who wanted to hold her. There were days when I only held her when I was feeding her. It was a great excuse to politely snatch her away and go snuggle somewhere quiet. Even after the visitors calmed down, it was still our time. Sometimes she would wrap her little arms around me and look up at me and straight into my heart. Sometimes she would wiggle her nose when she was eating hungrily, and it was more adorable than a thousand baby kittens. I can’t explain in words the feeling that nursing my baby creates. The scientist in me wants to cite hormone production, but whatever. It is a precious moment that you have to experience to fully understand. How could I give that up?

I started very early teaching her the word “mama.” Every time I said “mama,” I would show her the sign also (you touch your thumb to your chin with an open hand). One day when she was about 6 weeks old, she looked up at me with her big, beautiful eyes and very intentionally stretched out her little hand and touched my chin. Mama. My heart melted. It was adorable and precious, but it also reminded me that we still share a bond that is not food-based.

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Sweet, milk drunk baby… can you tell if it’s breast milk or formula? 

I also recognized that I didn’t give my friends the credit they deserve. I was so worried about being judged, I didn’t give them the chance to rise the occasion. It turns out, all moms struggle. All moms struggle because all moms are human and humans struggle. My friends understood. Some of them were also struggling with their feedings. Others had their own rocky road to travel. Instead of the judge-y comments, I got sympathetic looks and reassuring smiles.

The feeding debate continues in my head every day. Like most moms, I constantly wonder if I’m making the right decisions at the right time. Some days she practically crawls down my shirt. Other days, she acts offended that I offered her breast milk. Ultimately, I know my baby is cared for and loved. And that’s really what matters.

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Happy. Healthy. Loved. 

Top Ten Tips for Picky Eaters

I admit to being picky eater. Recovering picky eater. (I try). Between my own pickiness and my time counseling parents of little kids, I see that picky habits are easy to start early in life. All kids are different and have different needs. Luckily, there are a few things that I tend to see over and over again. Given that, here are my very best tips for picky little ones:

  1. Keep all foods on the menu

I see parents often remove items from the menu once a child says no to it. Please keep a few things in mind. First, “I don’t like it” may mean something else. Little kids are still learning to communicate. They may mean “I don’t want that today.” Or possibly “I was expecting this to be something else.” Have you ever taken a big gulp of a drink that was something other than what you thought it was? Just the other day I took a big ole swig of what I thought was water. Turns out, it was tea. I love tea, but it tasted like garbage because I was expecting water. Little kids don’t know how to properly express these feelings. Second, it can take several tries of introducing a new food before kids really accept them. Don’t give up too soon. Finally, they may not like how it was prepared. Which brings me to tip #2.

  1. Vary your cooking

I grew up hating broccoli. Turns out, I just hate the way my mom makes it. She steams it super soft, then puts lemon juice on it. I now love broccoli. I just need it tender crisp (sautéed or roasted) with some garlic. Yum! Little kids don’t understand that cooking methods and seasoning choices change the taste and mouthfeel of food. Help them learn that cooking is a creative outlet and foods can taste new by changing how you prepare them.

  1. Get them involved

When you involve your kids in the process, they own it. Then they are more likely to eat it. I know what you’re thinking. “But Stacy, I can barely scrape dinner together. You want me to add my kids to that hot mess?” Make it work for you. Maybe it’s taking them to the store and asking them to pick out one item for dinner. Maybe it’s naming the dish after them. Depending on their age and skill level, maybe it means having them wash it or put it in a bowl for you. Try making a game out of it. Take them to the produce section and ask them to pick out something red for dinner. Or maybe give them the choice of two side items. Make a big deal of it. Announce you bought carrots because your little one picked it out.

  1. Offer only one new food at a time

And serve it with something familiar. It can be overwhelming for little ones if they don’t recognize anything at the meal. If their current favorite is apples, serve that with a new veggie. They are more likely to accept new foods this way.

  1. Utilize resources

There are a ton out there. Ellyn Satter is the gold standard for pediatric feeding. Her website is a great place to visit. Fruitsandveggiesmorematters.org has a section just for getting kids to eat more fruits and veggies. Kidshealth.org is MyPlate for kids, and it has great information also.

  1. Resign as short order cook

Your family eats what is on the menu. Maybe you have days that you clean out the fridge and the plan is for everyone to choose their favorite leftover, or something similar. Otherwise, everyone has the same choice. When you short order cook for your kids, they learn to only want what sounds good in that moment. I don’t know about you, but that is a major struggle in my life. Sometimes, you can’t really tell what sounds good in that moment. Cue the what’s for dinner argument. “I don’t know, what do you want?” This phrase makes me feel frustrated just typing it. Let them know what’s on the menu so they are ready for it. What do you do when they ask for something else? You can tell them that sounds good, but it’s not on the menu today. Maybe you can add it another day.

  1. Be a good example

If the kids see you turn your nose up at a food, they will too. Monkey see, monkey do. Just like they will repeat every word you say, they will pick up on what they observe about food. When I was a kid, I thought diet coke was for girls and regular coke was for boys. My mom only drank diet and my dad only drank regular. Smile big when you eat those veggies, little eyes are watching.

  1. Forget preconceived ideas about food

When my niece was a baby, her favorite food was tofu. Yes, tofu. Her parents often ate at a nearby sushi restaurant. When she started eating solids, they needed something she could eat. The cook would prepare the tofu used for the miso soup for her. No one told her tofu was gross, so she didn’t know it was weird or yucky. She liked it coated in crushed up Gerber Puffs. (We figured that out after a baggie got smooshed in the diaper bag. She loved it.)

  1. Allow food to be experienced

It’s okay to let kids experience foods without eating, especially new foods. Forcing food down the throat of a screaming kid is traumatic for everyone involved. Instead, talk about it. Tell them the name and point out things about it. For example, name the color, discuss the texture, and so forth. Let them feel it, smell it, look at it. You can even have them touch the food to their mouths. This allows them to get acquainted with it.  Keep the portions small to avoid waste and keep them from getting overwhelmed.

  1. Know you are doing your best

If you can say you are doing your best, then rock on. Every day will not be perfect. Sometimes you will have to pick your battles. And that’s okay. Cut yourself some slack on the days you have PB & J for dinner. We are all human. We all need a little grace.

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How to Live with Gestational Diabetes

I have been lucky to have a relatively uneventful, healthy pregnancy. Until the end. The last month or so have brought… issues.

The most significant issue came when my doctor said the two words I was hoping to never hear – “gestational diabetes.” I know what you’re thinking. “But Stacy. You are a dietitian. How can this happen to you?” Firstly, I have a strong family history of diabetes. My dad is diabetic; my mom had gestational diabetes when she was pregnant with my brother. I have a grandparent and multiple extended family members who are also diabetic. My second risk factor is being over the age of 25. On top of that, most cases of gestational diabetes are hormone-related. I am pretty much a walking target for diabetes.

Getting a good plan in place for me has been difficult. I wanted to control my blood sugar, or blood glucose (BG) levels with diet. However, it wasn’t working. I felt so many things. First, my body was letting me down and I couldn’t control it. And the place that was created for my unborn daughter to be the safest and most protected was suddenly not the safest place for her. Even my beloved food was letting me down.

I met with a Certified Diabetes Educator (CDE). Even though I am already well educated on the diabetes diet and diabetes management, I think it’s important to not treat yourself. I went to a professional who does this every day to gain insight and to have an objective opinion. I also was referred to another doctor who specializes in diabetes management. She was super helpful. We quickly discovered I needed to be medicated. This brought a surprising feeling of relief. Of course, I couldn’t fix this with food, because food was never the problem. The meds helped, and my BGs started returning to a normal range.

The next hurdle I had to overcome was easily the most unusual for me. During a routine OBGYN appointment, my urine sample contained ketones. This is particularly dangerous for diabetics. It also is an indication that I wasn’t eating enough. NEVER have I ever had a problem NOT eating enough. So again, my plan had to be altered.

There is a misconception that the diabetic diet is a low carb or no carb diet. It’s all about eating a consistent amount of carbs throughout the day and making healthful food choices. And, no, that’s not the same thing. Would you like me to pay you a low sum of money or a consistent sum of money? Do you see the difference between a low dose of medication and a consistent dose of medication? For me, it became all about how to get in all the carbs I need. Focusing on what my body (and my baby) needs rather than what I shouldn’t eat really helped me come to terms with my diet and maintain a healthy food relationship.

The hardest part about being diabetic (and pregnant)? It’s easily what random people say to you. Every pregnant woman has had that person say something super inappropriate or unintentionally hurtful. “Oh my gosh, you are SO big!” “Should you really be eating that?” “You think you’re tired now? Just wait, you’re never sleeping again!” I could go on. But no one really argued with what I need. For example, as I assembled my plate, I might get a comment like, “Have some cake, you’re eating for two!” Instead of explaining that I couldn’t or shouldn’t eat cake, I would say something like, “That sounds good, but I really need more protein.” It kept me sane and unwanted comments at bay.

In the grand scheme of things, my diet really didn’t change that much. I mostly just paid more attention to portions. My husband and I often eat sauteed veggies tossed with pasta and chicken. It’s easy, cost effective, and reheats well. I also enjoy getting creative with different combinations of food, and incorporating as many different colors as I can. To make this work with my new needs, I left the ingredients separate. I could measure out how much pasta I could reasonably have and ensure my total meal met my total number of carbs. Check the package for exact amounts, but typically 1/3 cup of pasta is 1 carb serving. So, if you need 3 carb servings at a meal, you could eat 1 cup of pasta. Or, you could eat 2/3 cup and have something else. I dumped it all in the same dish and tossed so ultimately it was the same meal I would have eaten it anyway.

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For this meal, I used tricolor rotini pasta (the kind I bought is made with extra veggies). It is tossed in extra virgin olive oil with garlic and herbs. I sauteed red, yellow, and orange bell peppers and some fresh green beans. To this, I added shredded chicken and topped with Parmesan cheese. I added a side of fruit to round out my meal.

As usual, this is less recipe and more guidelines. This is a little different every time I make it, but the template is the same. This is also a great way to use up leftovers!

Tossed Veggies and Pasta

Pasta of choice

Veggies of choice (bonus for lots of color!)

Protein of choice, cooked and shredded or chopped. (I like chicken, but could use shrimp or vegetarian options)

Olive oil

Seasonings of choice

  1. Cook pasta according to package directions; drain and set aside. Drizzle with olive oil and season as desired. I used garlic, black pepper, and a little rosemary and thyme.
  2. Sautee veggies in a little olive oil under desired level of tenderness.
  3. At this point, I measured out the pasta according to my needs. If you do not need to count your carbs, skip this step.
  4. Toss veggies and pasta together.
  5. Add cooked protein. (I shredded up leftover chicken my husband had grilled the night before)
  6. Top with Parmesan cheese or fresh herbs.

Enjoy!

 

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The Joys of Pregnancy

The joys of pregnancy. This statement is equally ironic and literal. It is a wondrous and miserable time. It comes with weight gain and numerous feelings about said weight.  I have personally told numerous post-partem clients their bodies are amazing. “Your body made a person.” If I’ve said it once, I’ve said it a hundred times. And I meant it. Now I am experiencing it. Some days are all wonder and awe. Other days are all frequent urination, round ligament pain, pressure, exhaustion, and oh my goodness do I really have to pee again????

As I approach my third trimester, I am noticing definite growth. More than once, I’ve asked my husband, “Was I this big this morning?” I’ve also never been more comfortable in my own body. Don’t get me wrong, I have experienced both love and loathing of my body in the past. But somehow, this is different.

I think part of it is the wonder of it all. There’s a little person growing and developing inside me, and it’s amazing. I can feel her move, and there’s something incredible about that that I can’t even put into words. Part of it is I get to eat more. There’s no judgement for the pregnant lady who would like an extra roll.

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But I think what really makes me so comfortable is knowing my body looks how it’s supposed to look. There have been times in my life in which my insides and outsides did not match. For example, I had an injury that preventing me from working out. On the inside, I felt like strong, lean, active woman. But on the outside, my muscles wasted away and my body became soft. I was frustrated and embarrassed. Now, my weight is creeping up because it should. My belly growing means my daughter is growing. The numbers on the scale that used to make me crazy are just a number to me. They creep up each month, and I am at peace with it.

I believe very strongly that you are more than the measure of your waistline. Your weight does not define your value as a person. If you remember nothing else from me, remember that. After years of struggling with that concept, I finally feel it. I know after the baby is born, I will be back in weight loss mode. I know it will take time to get that weight off. And I’m okay with that. My body (and my baby!) is healthy, and that is what is important to me.

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Eating Seasonally (Not Another Pumpkin Spice Post)

It’s fall, y’all! Summer is officially over. It’s hard for me to get excited about all things fall here in southern Alabama.

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Southern Alabama in September 

Sooner or later, the days will get shorter and the air will get crisper. The humidity will drop below 100%, and you can wear jeans without being miserable. If you were expecting the next thing to be about how much I love Pumpkin Spice everything, we still need to get know each other a little better. I have zero judgement for you if you count the days until you can slow sip a pumpkin spice latte. However, some of us may have gotten a little too excited about pumpkin spice season (I’m looking at you, Pringles).

My favorite thing about this time of year is… apple season!

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I love apples. I know what you’re thinking. But Stacy, apples are easily the most boring fruit. I disagree.  There is a difference between being boring and being a staple. After all, apples are the symbol of health. And who doesn’t love apple pie? I love the crisp texture of an apple, how it can be juicy but not messy, and sweet, but not overly sweet. Apples are super versatile and pair well with many different foods. Apple and peanut butter? Delish. Apple and cheese? Yes, please. Apple and cinnamon? My fave.

So why all the excitement about apples? It’s because I just went all summer with zero good apple choices. There are few, over-priced, and underwhelming apples when they aren’t in season. And you cannot get that beautiful crispness that makes an apple in July. Essentially, it’s because I eat seasonally. Eating seasonally means that you mostly eat the produce that is in season. Here’s why I do it:

  1. Fruits and vegetables are their cheapest when they are in season.
  2. Fruits and vegetables are freshest when they are in season.

(Please note this is for fresh produce. Frozen fruits and veggies are picked and frozen in-season. They can be a good option if you just have to have something out of season.)

By buying fresh, budget-friendly produce it ensures that I get in my servings of fruits and veggies every day. The current recommendation is 5-9 servings of fruits and vegetables per day. More health benefits are seen if you are closer to the 9 than the 5. Our friends in Canada recommend 7-9 servings. I like your style, Canada. However, 76% of Americans do not meet the recommendations for fruit and 87% of Americans do not meet the recommendations for vegetables, according to the CDC. Baby steps, guys. We will get there. A great resource is www.fruitsandveggiesmorematters.org. It tells you what fruits and veggies are in season, budgeting tips, and recipes. There’s even a section on getting kids to eat more fruits and veggies.

I am lucky to live in an area that grows a lot of stuff. I have my choice of several local farmer’s markets and roadside stands. I get beautiful produce and can find super low prices, and support farmers in my area. It’s a win-win. Not sure about farmer’s markets in your area? You can search for them through the USDA’s website. For my fellow Alabamians, you can visit the Farmers Market Authority website and find everything you need to know about buying local.

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My current struggle is being excited for apples, but not quite ready to transition to fall. This means I’m not ready for apple cinnamon oatmeal or apple cheddar soup. Our temps are still in the 90’s right now. I need light, cool, summery meals. Until it cools off a little more, I’m eating my apples in my chicken salad.

Chicken Salad

Chicken, cooked and chopped or shredded

Non-fat plain Greek yogurt

Your favorite apple (I like Gala, but you do you), finely chopped with skin

Celery, finely chopped

Walnuts, chopped

Salt and pepper to taste

Parsley to taste

This is an eye-ball, dump, and stir recipe. You want to have just enough yogurt to coat the other ingredients. From there, make it your own by adding more or less of each ingredient.

What seasonal favorites are you enjoying? Are you as excited about apple season as me? Leave me a comment and let me know how you are getting your fruits and veggies!

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How I Get My Omega 3

My three-year-old niece claims to make the best guacamole. I did not believe it. I believe she makes the best mud pies. I believe she makes the best mess. But guacamole? I had to see it for myself. I watched as she squeezed limes with her tiny hands, and shook garlic salt into the bowl. (My sister did the cutting – safety first!) She made it with such care and joy. This is how all food should be prepared.

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Then it was time for the taste test. I have to confess, I’m not a big fan of avocado. Yes, not even in guacamole. But I’m working on it. I am a long-time picky eater.  I know this can cause me to miss out on important nutrients. I’m very focused on Omega 3 fatty acids right now. They are healthy unsaturated fats that are super good for you. Omega 3 fatty acids are linked to reduced inflammation in the body. Inflammation can be a marker of certain diseases like heart disease. (1), (2).  Food sources include fatty fish (don’t eat at all), nuts (only eat a little), olive oil, and avocado.  So far, I’ve only found two types of guacamole that I actually like. My friend makes one and a local restaurant makes the other. The chances of me liking a three-year-old’s guacamole is slim.

So, back to the taste test. I dug my chip deep into the guacamole and…it really was the best! I was shocked. I loved it. I went home and tried to copy it. Here’s the real surprise: it’s only three ingredients. Maybe the simple ingredients are what makes it so good? Maybe it’s the joy she poured into it? Either way, it now my go-to for a quick and easy source of Omega 3.

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Guacamole:

Avocado – as many as you like

Lime juice – to taste

Garlic salt – to taste

Cut avocado in half. Remove seed. Remove fruit from peel. Add lime juice and garlic salt to taste. Mash together.

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What is a Registered Dietitian?

I get asked this question a lot. What is a registered dietitian? What’s the difference between a dietitian and a nutritionist?

A registered dietitian (RD) is a food and nutrition expert. You may also see registered dietitian nutritionist (RDN). This is the same thing and these terms can be used interchangeably. To be an RD, you must have a bachelor’s degree in nutrition. Then you must complete an accredited dietetic internship. The internship is 1200 of supervised practice in Clinical Nutrition, Community Nutrition, and Food Service Management. Each program may have a different focus or specialization, but all programs must provide a minimum number of hours in each category. Once you have completed the internship, you are eligible to sit for the RD exam. It is a hard test. It contains everything you have learned over the course of 5 or 6 years. If you pass this exam, you may now use the credential RD. Many states have license laws. This means you must also carry a license to practice. You must be an RD and maintain continuing education credits to have a license. Soon, dietitians will also be required to have a Master’s degree in Nutrition. (You can read more about how to become an RD at eatright.org)

A nutritionist means nothing. There is no standard for what that means. Someone who claims to be a nutritionist may have taken a certification course or had no education in nutrition at all. Literally anyone can call themselves nutritionist.

If it takes all that work to become a registered dietitian and little to no effort to be a nutritionist, why become a dietitian? Glad you asked.

  1. To ensure you are qualified to give nutrition advice. Would you hire a lawyer who didn’t go to law school? Even if he had a certification? Keep in mind personal experiences do not count as qualifications. I have had abdominal surgery. But I have no business performing surgery on anyone.
  2. You have little or no job opportunity. Most states will require that RD to have a job in anything nutrition related. Check with your state to ensure. Here in Alabama, you can work at WIC and that is it. Practicing nutrition without a license is considered illegal and charges can be brought against you.
  3. If you are passionate about nutrition, please go live up to your potential. Dietitians are all passionate about different aspects of nutrition, and we need more people with more passion in this world. Don’t sell yourself short by cutting corners.

Becoming an RD is a lot of hard work and struggle. It was 100% worth it. If you are an aspiring #rd2be, study hard. It’s a great profession.

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