HOW TO PROTECT YOUR BREASTFEEDING RELATIONSHIP EVEN WHEN YOUR BABY IS NOT FEELING WELL | SERIES THREE

SICKNESS BLOG SERIES: #3 Vomiting and Diarrhea

​We’ve all been there. It’s 3AM and we hear it. A cough. Throwing up. A cry that just doesn’t sound right. One of my jobs as a pediatric nurse is phone triage. Parents want to know how to treat their child at home, or when it’s a more serious problem that should be addressed by a physician. This blog series is not meant to be medical advice and if you have concerns about your child, you should call their doctor or seek emergency care. But I’ll go over some basic symptoms you might encounter in your baby’s first year, and how to protect your breastfeeding relationship while you work through them.

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​Vomiting and Diarrhea

Is there anything worse? Not only is vomiting and diarrhea terrible to experience yourself, it’s so much worse to see a little baby throwing up and so incredibly sad. As moms, our go-to move is to immediately rehydrate them. That might not be the best idea, for reasons I’ll get into here. Plus it’s contagious, so it’s very possible we’ll be sick ourselves while caring for a sick baby. Nightmare. Here are some general tips for all babies. ​

• The younger they are, the easier it is to become dehydrated. Vomiting and diarrhea in a newborn can dehydrate them in mere hours. Always watch wet diapers. For a sick older baby, one diaper at least every 6-8hrs is the minimum. In a sick newborn, look for every 4-6hrs. 
• Eyes and soft spots that look sunken are signs of dehydration, as well as the mouth feeling dry and skin being less elastic. It’s best not to wait until you’re seeing these later signs of dehydration to get help for your little one. 
• If you’re having a hard time figuring out if your baby is peeing amidst all the pooping, tuck cotton balls or some Kleenex around the front of their diaper to act as a poop barrier so you can tell how often they’re peeing. 
• Vomiting is usually short-lived, but diarrhea is the gift that keeps on giving. Just because the poop situation is still weird a week later doesn’t mean they’re still sick. Their systems just don’t bounce back as quickly. Keep them hydrated and give it time. Older babies on supplemental feedings benefit from starchy foods and avoiding anything greasy or sugary until things have calmed down. 
• Your doctor can’t do much about this situation other than tell you if indeed your baby is dehydrated. Some will give medicine to temporarily stop the vomiting long enough for you to get some fluids in, but if you’re worried about a bug like this, it’s best to head somewhere that can administer an IV if needed. It might not be, but it’s best not to make multiple stops and drag your poor baby all over the place. 
• This is the big one. When they puke, Do. Not. Immediately. Give. Them. Fluids. Don’t do it. Put down the Pedialyte. Leave them alone. The last thing you want to do is let them irritate an already angry belly by flooding it with something it doesn’t want. And usually, when it rains, it pours. Very rarely with a gastro bug will they just throw up the one time. The faster they empty everything out, the faster everything will calm down. I know it goes against everything that feels right, but trust me on this. Wait until an hour has gone by with no pukes while watching for the warning signs above. Then start with tiny, frequent amounts of fluid. 
• Clear fluids ONLY for 24hrs. This is where you have to get mean. The only exception is breastmilk. What’s a clear fluid? If ya can’t see through it when you hold it up to the light, it ain’t a clear fluid. Pedialyte, apple juice (no for diarrhea), broth, jello, a mashed up popsicle. These all count, and they have calories for older babies. Babies under 6mos just need milk. Advancing to a normal diet just because a tummy has been quiet for a few hours is a good way to reactivate the puking. ​

Vomiting and diarrhea in a breastfed baby

• NO MATTER WHAT ANYONE TELLS YOU, breastmilk is THE best rehydration fluid on the planet. I will fight anyone who says otherwise, and science backs me on this. Not only does it have water, it has electrolytes that are easy to absorb, it has probiotics, it has probiotics to help heal their poor bellies, it has antibodies to fight off this foulness and get better more quickly, and best of all, it has SIgA, the magical substance that coats their bellies to help keep out bad guys. They need your milk! Pedialyte pales in comparison.
• After they’ve gone an hour without puking, nurse for 5 minutes. They might be super sad you cut them off. Be the bad guy. Chugging milk into a sad stomach is a great way to start puking again. If they keep their milk down for 10-15 minutes, try another 5 minutes. Keep this up for another hour, then it’s safer to let them nurse for a bit longer. Small, frequent amounts of breastmilk stand the best chance of getting absorbed quickly before more puking happens. Hydration is the goal here. 
• If your baby is just too sad and sick to nurse, don’t panic. Pump to replace missed feedings, and follow the same routine above. Only instead of nursing for 5 minutes, give them a teaspoon of foremilk on a spoon or syringe every 5 minutes. Foremilk is thin, sugary, and watery. You’re making your own Pedialyte. Go you!
• Don’t give oral probiotics to your baby. Your milk has probiotics and the last thing you want to do is add something else to the mix. Bacteria get into your milk, good and bad. You can very easily make sure your milk has plenty of good bacteria by boosting your own intake of lactobacillus. Find a probiotic with several strains, take 2-3x the amount an adult human would normally take per day, and let your milk do its thing. 
• If you have oversupply and you’re doing short, frequent feedings for a puking baby, buckle up. In a day or two, you’re probably going to be dealing with a supply boost. Follow your original oversupply care plan to get back on track. If you don’t have one, now is a great time to reach out to one of our LCs to get one! Oversupply comes with a whole host of problems for mom and baby. 
• You’ll probably get sick. Sorry, sister. It’s a fact. Inhaling puke droplets and changing diarrhea diapers make it almost unavoidable. You can hose down your entire house in bleach, but you’ll probably still get sick. Your partner who’s sleeping soundly in bed while you’re holding a puking baby over the toilet probably won’t get sick. Yes I’m speaking from experience. No I’m not bitter. Your milk is still good. You might have heard your supply goes down when you get a virus like this. Not entirely the case. Many times we skip nursing sessions because we’re miserable, and we don’t pump. Less stimulation can always lead to a temporary slow down in milk production. The best way to prevent this is frequent milk removal. I know. You feel like dying. Last time I had this, I just laid on the couch like a topless corpse while my son latched himself on at will, then crawled away to play. He thought it was the best thing ever and nursed all day for fun. Instead of having a dip in supply, when I was feeling better and back at work, my pumping output was UP because of all the nursing. Go figure. If you’re too sick to nurse, at least try to pump to replace feedings if you can to protect your milk supply. 
• A fun fact for older kids. My 10yo had this last Fall. After following the “no fluids until 1 hour puke free” rule, the very first thing I gave her was an ounce of her brother’s pumped milk in a cup. Anyone can benefit from the healing properties of your milk. Not only did she keep it down, she said it stopped the painful cramps in her stomach and she was up playing in no time and asking for waffles (she was not allowed to have waffles until the next day). It’s THE rehydration fluid of choice for an illness like this, so don’t be afraid to give it to older siblings if you have the milk to spare. 
• If little bottoms are raw and red from all the diarrhea and you have milk to spare, a milk bath can be really soothing to painful, irritated skin.

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Sick babies are never a good time and it can be really scary. Always, if you EVER have a gut feeling something is just not right, it’s better to be safe and get baby checked out. Sometimes the peace of mind is worth the copay, and things can change quickly in little ones. But hopefully these tips will help you care for your breastfed baby so you can handle their illnesses with confidence.

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author

Hey! I’m Allison, one of the Lactation Experts with Successful Breastfeeding! I am an International Board Certified Lactation Consultant (IBCLC) and have over seven years of experience as a pediatric nurse working one on one with mothers and babies. My most important credential is being “Mama” to two little ones. ​I am so happy to be part of the Successful Breastfeeding team; to be able to offer support in a more relaxed setting! I can help you meet your breastfeeding goals no matter where you are - virtual sessions for convenient, accessible help no matter where you live. Breastfeeding is a relationship between you and your baby, and it’s my job to support it, whatever your goals and needs happen to be.