Friday, November 12, 2010

Nasal congestion affecting breastfeeding: What to do?

Baby burrito the day of birth with daddy
Big baby, little nose

When Mikko was born, we had a lot of trouble the first week or so getting started with breastfeeding. Part of it was terrible hospital interference from a nurse who didn't understand that colostrum is meant to be a drip rather than a flood, that milk quite normally can take days to come in, and that a baby who has IV fluids during birth (and who weighs a lot to begin with) can afford to lose a few ounces in the first days without negative consequences. This nurse gave Mikko a bottle of formula, and it set us up for a week of misery until we could fully breastfeed again.

But another reason we had so much trouble persuading Mikko to breastfeed was his sadly stuffy little nose.

Babies are, as our midwife-lactation consultant put it, "obligate nose breathers," meaning that for physical reasons babies will breathe through their noses whenever possible and find it difficult to breathe through their mouths. And when a baby latches on to nurse, she must breathe through her nose while she drinks, because her mouth is full of breast!

Breastfeeding can become a challenge when a baby is having trouble breathing through his nose for one reason or another, whether because of physical deformities or an occasional cold.

We found out, through our midwife, that it's quite common for newborns to be born with tiny nasal passages, and it's also common for those small passages to be clogged with mucus left over from the birth. It can take awhile for the passages to expand and the mucus to dislodge — for us, it was at least a couple weeks before he was breathing easier.

And, even so, whenever Mikko caught a cold as a toddler, breastfeeding became once more challenging for him.

Here's the problem with a congested nose and a baby who dearly wants to nurse: She latches on and can't breathe. She gets upset and lets go of the breast and starts crying. Now she's more congested with all the snot flowing, and the next time she tries to nurse, it's even worse than before! It's a vicious cycle.

So here are the steps we took to ease our baby's congestion, during the newborn phase and afterward whenever it occurred. I hope one or more might work for you and your stuffy nursling.

  • Steam. This is a go-to and safe solution for even a small infant. Run a warm to hot shower or bath and sit in the bathroom with the baby to nurse. You can choose whether you want Newborn baby in the big bathtub with mamato sit in the water or merely nearby. Normally, I wouldn't recommend the bathroom as the best place for your baby to eat, but desperate times call for desperate measures. Anytime either Sam or I took a shower in those first couple weeks, the other of us would hold the baby in the bathroom to take advantage of the steam. And I took a soothing herbal bath with Mikko almost every day, which served multiple purposes of calming him, healing my body physically from the birth, and gently opening his nasal passages. If you don't mind wasting water, no one actually has to be in the bath or shower for this trick to work. Just close the door and leave the exhaust fan off.
  • Vaporizer. This is a similar method but can be used all day and night and in any room. We bought a relatively inexpensive vaporizer at the drugstore — actually, my parents bought it for us while they were visiting. You fill the reservoir with tap water and a little salt. When you plug it in, it emits a constant stream of moist, warm air. You can add a little touch of scented balm or essential oil to the little tray at the top, so the scent is released as the steam passes by. The brand of vaporizer we bought was Vicks, so it was intended to be used with the menthol VapoRub. But we use an organic mint essential oil instead and just place a couple drops in the tray for the night. It's best to be located fairly near the vaporizer to feel the effects, so we put it near the bed before we go to sleep. If you're still on your babymoon or are sick yourself and are staying in bed or on the couch all day, you could easily have it next to you during the day as well. When the reservoir runs out, the machine shuts off, so you'll just want someone to refill it for you as needed. (This is where a personal servant comes in handy.) If a vaporizer is out of your budget or preferences, you can use a pot of hot water or crock pot instead with a few drops of mint or eucalyptus oil.
  • Aromatherapy. Speaking of those essential oils, you can dab a little on your chest. Never put the oils or menthol on a baby's skin, because they can be too strong for newborns. And avoid putting them too near the nipple area, because you don't want your baby to taste them and be turned off by breastfeeding any further. Just trying dotting a tiny drop in between your breasts but up a little higher on your chest wall, so your baby can smell it and feel the effect of clearing nasal passages.
  • Sleep sitting up. I love this tip for myself when I'm congested, propping pillows behind me so I'm only semi-reclining when it's time to sleep, so it was a combination of
    flying with mei tai and baby and mama
    Sleeping upright on your chest is cozy for little ones.
    Mikko's and my instinct that allowed us to reach the conclusion that he sleeps better in a half-reclining position when he's feeling stuffy. As a toddler with a cold, he would sit up in bed and flop his upper body over onto my chest to nurse and fall asleep like that. Experiments with trying to lay him down too soon revealed to Sam and me that having Mikko sleep just the way he preferred to during a cold was the best way for him to breathe more clearly and get the rest he needed. You can combine the two techniques by putting pillows behind your own back (I find a specialty pillow like the WondaWedge or a "boyfriend" / bed rest pillow gives me a more secure foundation for putting bed pillows on top) and then having your baby or toddler lie in an upright position either on your chest (small baby) or across your ches (big baby). If you get tired of sitting up later in the night or if you feel like your baby is slipping, you can usually lay him down flat after he's in a deep sleep and he'll now be able to sleep all right in that position until the next waking.
  • Breastfeed sitting up. As an extension, even during the day, your baby will probably do better in a more upright feeding position. Kellymom recommends any of these upright positions (with pictures!). Consider that the technique of allowing an upright baby (even a newborn) to self-latch is very common in, for instance, Africa; Mikko had instinctively shown me this technique as an older baby, but I didn't realize until I read the above article (linked by Authentic Parenting) that it could be preferable for younger babies as well.
    Nursing in the Sleepy Wrap
    Nursing and babywearing in an upright position
    However you and your baby want to manage it, a more upright position will help prevent postnasal drip and make your baby feel less congested than when lying down.
  • Use breastmilk as medicine. This is twofold. First of all, keep nursing as much as possible, because your antibodies will help your baby heal and will soothe symptoms like an inflamed throat in the meantime. The extra cuddles will help comfort your baby emotionally. The increased liquid intake will stave off dehydration. And, if your little one is anything like mine, breastmilk is the only nutrition she might get during an illness. (Good thing it's such a good one!) You can also use breastmilk to help clear congestion and heal specific hot spots. For instance, Mikko was born with a clogged tear duct (also very normal). I dripped breastmilk on it straight from the breast and massaged it occasionally. If you hand express or pump a little breastmilk into a dish, you can use a small syringe without a needle (the pharmacy counter will give one away for free) to suck some up and then squirt it wherever it's needed: up a congested nose or into an infected ear, for instance. Kellymom gives tips on how to use saline or breastmilk as a safe decongestant. The saline or breastmilk will help dissolve some of the dried mucus and get everything (including air) flowing again for breastfeeding to take place.
  • Consider appropriate supplemental feeding techniques. I put this one in here with great caution, because it won't be an issue for 95% of breastfeeding babies, and I don't want it to come off as a first or even second choice when a baby's having trouble nursing due to congestion. It's just that my experience with Mikko showed me that a baby who's having difficulty with straight breastfeeding might be able to get nutrition down more quickly during severe congestion with an alternate method of breastmilk ingestion. But I would choose one, always, whenever possible, that supports breastfeeding success and doesn't replace breastfeeding. This will then mean pumping milk and perhaps feeding it with, say, a needleless syringe or feeding tube, at the breast if possible. Please use this method only under the guidance of a qualified lactation consultant who can help you determine if it's really necessary and how to do it in a way that won't interfere with your future breastfeeding relationship. I found it very frustrating and limiting when I had to feed Mikko this way so don't recommend it if it's not absolutely essential. It might be something you do at a feeding only to take the edge off hunger, following up with straight breastfeeding once the baby has calmed enough to nurse. For older babies and toddlers who are having trouble nursing, Kellymom suggests using expressed breastmilk to make frozen or slushy momsicles or adding it to solids.
  • Keep calm. This is for you and the baby. I know Sam and I were getting very upset about how upset Mikko was, and hearing a wiser voice (our midwife) come in and tell us it was normal and would pass was so important. Try, if you can, not to freak out, so that you can help keep your baby from doing the same. (It's OK to be sad, though! I understand.) As for keeping your baby calm, there are a few things that might help. First of all, try to start feeding your baby before any strong hunger cues so that it doesn't trigger the cycle: A frantically hungry baby will likely already be crying and will be prone to stronger frustration when feeding doesn't go well. Go ahead and encourage comfort sucking so the baby can nurse whenever he feels like it.
  • Give it time. Barring any chronic or severe physical concerns (in which case, I hope a pediatrician is giving you expert advice), it will get better. If the problem is a newborn's tiny nasal passages, newborns do just about little else but grow. If the problem is congestion due to illness, it will run its course, and any breastfeeding you can do will help it resolve faster. If the problem is a delay in your milk coming in, it will start flowing when it's ready. It's so hard for both of you when you're in the middle of it, but time will eventually work its magic and you'll find your way through.

How has congestion affected breastfeeding for you? Any more tips to share on nursing a baby through an illness?


meaningfulmothering said...

I really liked this article. Our little boy has tiny nasal passages. He was congestion for the first 6 weeks or maybe longer. Thanks for the tips. We often use the warm shower technique, Ender loves the water so it is a double benifit.

Kristin @ Intrepid Murmurings said...

Great tips! Man, we have suffered through our share of sick nursing babies/toddlers around here and its no fun, for sure. For us, the humidifier plus sleeping/nursing sitting up or at least on an incline works best. We have a triangular wedge shaped pillow that works well. When it was really bad with Emma I would have her sleep in an upright position (nursing if possible) in a carrier (I didn't get much sleep myself those nights!). We also have a Nosefrida ("snot sucker") that can help a lot (not sure if its okay for newborns, though!) -- way way better than the bulb syringes!

Now, when my girls want to nurse and are too stuffy my girls just ask for a tissue, or run and get their own. Its great! We have come so far! said...

Vicks rub did wonders for my son and for my daughter breastfeeding was the only thing that helped. The sucking motion seemed to help her nose get unblocked as well as provide comfort.

Momma Jorje said...

Wonderful tips! I had to nurse in the bathroom a few times for the steam as well. I also used the saline drops "Little Noses." She didn't like them much, but it wasn't bad and it helped.

One thing I would suggest, if you're sitting in the bath with baby for the steam, is that bubble bath stuff that has... eucalyptus or something in it. They make a lavender one, but the minty / eucalyptus one is good for clearing sinuses.

Geigerin said...

We had similar hospital interference, and it took our little one 3 1/2 weeks to latch. The nurses are well-meaning but sadly misinformed in some cases.

Thanks for sharing the tips! I especially love squirting the milk up our girl's nose and hanging out in the steamy bathroom. Sometimes, having breastmilk is like having a superpower. :)

Acacia @ Be Present Mama said...

Just wanted to give kudos for the post. Kellan had a congested nose for almost 6 weeks after birth. Luckily it didn't affect our latch *too* much and he's a happy nurser now! I take Kellan in a warm steamy shower and sit over a steamy bowl of water and aromatics whenever he gets stuffy and find that works well.

Olivia said...

Thanks for this post! My daughter has been stuffy for a couple of weeks with allergins in the air. This mostly interferes with her nursing at night (my god, she was restless last night!). I always forget to use steam, so I will set up our humidifier tonight and try positioning her across my chest.

Sheila said...

My little guy was congested for about a week when he was 2-3 weeks old. It was truly awful because he wouldn't sleep lying down, and I couldn't sleep sitting up.

Last time he was congested, at about six months, the only way I could get him to nurse when he was really upset was to start with a bottle and switch to the breast once he'd had a little. Otherwise he was too impatient to suck through his stuffy nose, and his crying made it so much worse.

cartside said...

thanks for all of those tips! My younger daughter is 9 weeks and still very congested and this is just the information I needed.
I've been using saline drops but it doesn't seem to help much. Sleeping upright works great, but at night this is difficult (during the day she always naps upright in a sling and sleeps well like this).
I really hope she'll grow out of it soon - fortunately feeding is going ok, it's only occasionally affected by her congested nose (like just now...)

Amyables said...

What a wonderful post, Lauren! I though you were looking for advice, and clicked over in order to share some ideas, but then I realized you covered them all (and more!) and beautifully!

Lauren @ Hobo Mama said...

@Amyables: Aw, thanks! I was wondering if our current newborn would be stuffy nosed at first like his brother, but things were much easier this time!

Maire said...

Plug in oil burners can be great as well - as you can add essential oils to them and leave them on all night. Obviously you wouldn't put in too many drops - some Lavender and Eucalyptus Radiata is what I have used to help ease congestion when they are tiny babies and breastfeeding, as they get older you can add Tea Tree and increase the dosage

Andreane said...

Great great grrreat article! So very helpful. My little 4 month old Louis is just going through his first cold, it is so sad! Daddt just had to go on about how we never get sick to bring a terrible bug home! Lol! Louis' always struggled with hard boogers, I have caught on recently that even though the air humidity level reads fine in the house, we burn a wood stove for heat so this may be causing dryer air and bigger boogers, I plan on getting a humidifier asap! I have had an aromatizer since shortly before he was born, I love essential oils! But you must educate yourself on them as they are potent! A lot of them are not recommended for babies or even toddlers. Peppermint is a big no-no for babies, even kids up to 6! It is so potent it can hurt their eyes or trigger seizures, in epileptic people. Always try and diffuse the oil before baby is in the room and always mix with base such as coconut oil for skin application or the bath, never on the baby or anywhere on yourself where baby can touch the oils and bring them to his mouth and face. :) Though his big boogers have always been around (we call it the weekly big boogie), he just sneezes them out. But with the cold, the snot made it hard to breathe through his nose and he was frantic, crying so hard, it was the saddest! The saline drops and snot sucker freaked him right out! So the breastmilk up the nose/steamy bathroom hang out/Jolly Jumper incline pillow in his bassinet/Coryzalla homeopathic drops for colds 1 month - 6 years before bed time did the trick SO well! He went down at 9:30 after a good long feed, coughed a few times through the night and woke up at 8 the next day, a verry happy and much less congested baby! Again thanks for the great article! Xo

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