Friday, June 22, 2012

Want to breastfeed a NICU baby? Yes it’s possible!

I will reveal one thing about Lil Guy’s health – he had surgery and an extended stay at a children’s hospital right after birth, and he didn’t really eat for the first two weeks as his doctors waited to introduce him to food.

Thus, being in the NICU did not bode well for my hopes to breastfeed him.
Still, I was adamant to his doctors and nurses that when he was allowed to have milk, he was to be exclusively breast fed. Actually, I think the conversation went something like this in the hospital…

"If you so much as give a drop of formula to my child I’ll sue you all."

Yes. I was THAT mother in the NICU.

To be fair, as a mom, it was the only thing I felt I could do to help Lil Guy at the time.  If you are a new mom and stuck in the NICU on an endless repeat of the same Groundhog Day, know that it is possible to breastfeed a sick newborn.
Here are 10 tips you might find handy:
  1. Rent a hospital grade breast pump. Even the fanciest pump at Target isn’t going to cut it to help establish an initial supply. Hospital rentals are surprisingly more affordable than you would think and with Obama’s new health care plan, they might be reimbursable.* Some children’s hospitals carry them too so if you’re going to be visiting yours for a long time, check out their pharmacy for a rental.
  2. However, the hospital grade pumps are BIG and HEAVY. I had the Medela Symphony and it was like carrying around a DJ turntable only not nearly as cool. Your NICU might have pumps on site that you can borrow and just bring your personal pump kit. Sometimes you can pump at the baby’s bedside with a screen shield. Other NICUs have separate pump rooms available down the hall. Just get a bag for your pumping supplies and some liquid dish detergent to clean on site. I was able to air dry my supplies in a clean plastic tub that I kept out of the way in the NICU.
  3. Keep a pumping chart with the day, time pumped and amount pumped. It’s frustrating to establish a supply when pumping because you can see the volume coming out and… it’s not a lot in the initial weeks. The chart will help you see changes in your supply – you should slowly start to see your supply increase as the weeks go on.
  4. Talk to your OB/GYN, NICU nurses, lactation consultants, etc. You will find different levels of measured support and conflicting opinions. That’s okay! When I talked to “experts” they differed a lot on how often to pump. I found three hours in between to be helpful at the beginning. When I tried to switch to every four hours, I felt like my body was starting to realize the baby wasn’t there. Your schedule may be different. Remember, even if you don’t get a lot of milk after let down, it’s still a signal to your body that the breast is empty and needs a refill.
  5. Nurse as soon as you can in the hospital so your child doesn’t lose the latch instinct. Be insistent to the doctors but be flexible. Lil Guy’s doctors agreed to let him nurse after I pumped just to keep his latch instinct. Ask the hospital to use the lowest flow nipples possible – babies will get lazy with higher flow nipples and they can sometimes refuse to latch after being bottle dependent.
  6. If you can, smell your infant before pumping or smell something he/she’s been wearing for a while. A baby’s smell is really important in establishing a supply. Supposedly, infant and mother can identify each other by smell within 24 hours of birth. Don’t wear perfume or scented lotion and request that your NICU visitors do the same so the baby isn’t confused by artificial scents.
  7. Sleep and nourishment are key. It is really tough to take care of yourself when you have a child in the hospital, especially if you have other kids at home or need to go back to work. This is where your spouse needs to buck up! They should always be reminding you to eat, drink and sleep when possible and they should be doing everything in their own power to make that happen. Keep a big bottle of ice water handy at all times. Get family and neighbors to drop off casseroles or heck, just go get some take out and worry about dropping the weight later.
  8. Don’t worry about the pacifiers. If your baby is getting a lot of pacie time in the NICU – perhaps to help pain management or keep them distracted for additional tests – it won’t hurt your breast feeding – in fact a new study found it may help. We like to use Soothies brand.
  9. Some CF babies seem to have a lower appetite. This was hugely apparent with Lil Guy, especially after having Big Guy (who was and still is a BIG eater). When your CF baby starts eating on his own, you may need to put him/her on a feeding schedule. Lil Guy kept sleeping through the night and I was really worried about his weight gain as a result. So we woke him up at regular intervals to eat. He wasn’t happy about it but tough love.
  10. Be your biggest cheerleader. Breast feeding a NICU baby takes a LOT of work. And you will find a surprising lack of support among family and friends who want what’s best for you and to see you get some sleep. What got me through the long nights was trash TV like Mob Wives and DVRed shows.
Finally, as an FYI, I asked Lil Guy’s pulmonologist if breast feeding moms of CF babies needed to eat a high fat, high sodium diet to pass on to the baby and the answer is NO. So unfortunately breast feeding a CFer is not a license for mom to eat McDonalds every day. Oops.

* It remains to be seen if commercially-available pumps will be covered (just read the fine print of Aetna’s latest policy here)

Tuesday, June 19, 2012

Where it counts: French fries

Here’s a quick tip - I was browsing the excellent double freezer selection of frozen potato products at Target this weekend and came across a difference in fries. They have regular French fries and something called “fast food like fries.” The “fast food” version had a lot more fat in them. So it pays to read labels for fries apparently. I had Lil Guy with me so couldn’t pull out my camera out but I’ll try to post photos of this subtle difference later.

Saturday, June 2, 2012

Recipe: Turkey Meatloaf Sandwiches

I have to give credit to Giada DeLaurentiis for the original recipe, and my best friend from my high school years for showing me how to make it with some alterations that make it easy for a novice cook like me.

Picture of Pancetta and Turkey Meatloaf Sandwiches Recipe
Photo courtesy of the Food Network
  • 1/2 cup plain dried bread crumbs (alternatively you can use Italian breadcrumbs and just leave out the next ingredient)
  • 1/4 tsp of Italian seasoning
  • 2 large eggs, lightly beaten
  • 2 tablespoons whole milk
  • 1/2 cup grated Romano (don't use the shredded kind)
  • 1/4 cup chopped sun-dried tomatoes (look around the veggie counter at your local grocery store, sometimes they sell ones that are already julienned and come in a resealable bag)
  • 3/4 teaspoon salt
  • 3/4 teaspoon black pepper
  • 1 pound ground turkey, preferably dark meat (I really like Perdue's version)
  • 1 package of bacon, preferrably without too much fat on it (cooks easier that way)
  • 4 to 6 Italian rolls (We like Gonnella's cut top hamburger buns)
  • 3 cups arugula, about 3 ounces
  • 1/2 cup mayonnaise (we prefer Hellman's)
  • 1/2 cup sour cream

Preheat the oven to 375 degrees F.

In a large bowl, stir together the bread crumbs, seasoning, eggs, milk, cheese, sun-dried tomatoes, salt, and pepper. Add the turkey and gently mix to combine, being careful not to overwork the meat. Sometimes I use my hands to get it all together and shape it into a loaf.

On a baking sheet lined with parchment paper (NOT wax paper), lay out the bacon strips vertically, overlapping the edge of the slices slightly, until you've made a large rectangle shape. At one end of the rectangle, place the turkey loaf. Using the parchment paper, wrap the bacon up and around the turkey loaf to cover completely. You might need to fold the ends (with the ends of the bacon) under the loaf. This is the trickiest part of the whole recipe, you can always reshape the loaf in the parchment paper if it gets squished in this process.

Place the parchment paper-covered loaf on another sheet of parchment paper - this will help absorb the grease that will come out from the bacon while cooking and won't make as much mess of your baking sheet. Bake the loaf until the internal temperature reaches 165 degrees F on an instant-read thermometer. This usually takes about 1 hour 15 minutes in our oven and we cut the meatloaf in half about 45 minutes into baking to make sure the center is cooked well. Remove from the oven and let cool.

Sauce (optional) In a blender, combine the arugula, mayo and sour cream and process until smooth. Store in the refrigerator until ready to serve.

To make the sandwiches, slice the rolls and spread with the sauce. Slice the turkey meatloaf and place on the rolls to make sandwiches.

My Notes
Once you get the hang of rolling up the loaf inside the parchment paper, this is an easy recipe for the whole family to enjoy. Unfortunately the original recipe doesn't list any nutritional information. But anything wrapped and baked in bacon is bound to be heavier on the fat content, right?!

To add extra calories for CFers, toast the bread and spread some butter on it, add a slice or two of cheddar cheese, and don't be afraid to use that sauce (or sub in some ranch dressing).

If you're trying to low-carb it, serve it like regular meatloaf (but I have to tell you it's delicious on a gourmet hamburger bun). To strip calories for non-CF family members, you can skip the sauce and trim off the bacon before serving.
Lay out strips of bacon, place meatloaf at one end. Starting from the right, roll the meatloaf down to the left with the parchment paper.
Fold the extra ends of the parchment paper (with the bacon) underneath the meatloaf; reshape the loaf if some shifting has occured.
Cut meatloaf in half about 45 minutes into baking to help center cook nicely. Note the extra parchment paper helps soak up the bacon grease!

When fully baked, cut parchment paper away from loaf and slice into thick burger-style slices.

And serve! CFers don't forget the extra mayo/sour cream topping! (Yes, ,that is Chinet.)