The Lactation Support program at CHEO is a team of NICU and pediatric registered nurses who are also International Board-Certified Lactation Consultants (IBCLC) and are specially trained to provide lactation support to families with sick infants and children. We can help parents who are having challenges with pumping or breastfeeding. We are primarily available to families of patients who are admitted to CHEO but can also see families in our clinics or the Emergency Department as needed.
If your child is not currently admitted to CHEO and you need lactation support, please contact your birth hospital, visit ottawabreastfeeds.ca or contact your local public health unit to find lactation support in your area.
About us
Mission, vision and values
|
Mission |
| Our mission is to provide comprehensive and compassionate lactation support grounded in evidence-based practice. We are dedicated to optimizing family and infant health outcomes by providing best practices in lactation support and adhering to the International Board-Certified Lactation Consultant and College of Nurses core values. We empower families to make informed decisions regarding their infant feeding plans, promoting a nurturing environment where every family feels respected and valued. Together, we are dedicated to promoting the lifelong benefits of breastfeeding and supporting families along their feeding journey. |
|
Vision |
| Our vision as CHEO's Lactation Support Team is to be recognized as a benchmark organization for lactation support services, setting the standard for excellence in evidence-based practice, family-centered care, collaboration, and empowerment. We envision a future where every family feels empowered and supported in their breastfeeding journey, where healthcare professionals seamlessly collaborate to optimize maternal and infant health outcomes. We envision growth in hospital-based services and in providing education and resources to our surrounding health care organization to use in promoting lactation support. |
|
Values |
|
Contact us
Phone: 613-737-7600, ext. 6874
Email: lactationsupport@cheo.on.ca
Hours: Monday to Saturday, 8 a.m. to 4 p.m.
Jump to the information you need
About breastfeeding/chestfeeding
The Canadian Pediatric Society recommends that babies exclusively breastfeed/chestfeed or are offered human milk for the first 6 months of life and then continue breastfeeding/chestfeeding while introducing complementary foods until the child is 2 years old or older
|
Benefits of breastfeeding/chestfeeding |
||||
| Breastfeeding/ chestfeeding has health benefits for both babies and mothers. Human milk provides babies with ideal nutrition and supports growth and development. Breastfeeding / chestfeeding can also help protect baby and mom against certain illnesses and diseases.
Human milk is the best source of nutrition for most babies. As the baby grows, the mother’s breast milk will change to meet the baby’s nutritional needs. Breastfeeding can help protect babies against some short- and long-term illnesses and diseases. Breastfed babies have a lower risk of asthma, allergies, obesity, type 1 diabetes, sudden infant death syndrome (SIDS) and are also less likely to have ear infections. Breast milk shares antibodies from the mother with her baby. These antibodies help babies develop a strong immune system and protect them from illnesses. Mothers can breastfeed anytime and anywhere. When traveling, breastfeeding can also provide a source of comfort for babies whose normal routine is disrupted. Breastfeeding has health benefits for the mother too! Breastfeeding can reduce the mother’s risk of breast and ovarian cancer, type 2 diabetes, high blood pressure, and postpartum depression. |
||||
|
When should breastfeeding start |
||||
|
Breastfeeding should start as soon as possible after delivery, ideally in the first hour. If you are separated from your baby due to illness, start expressing your as soon as possible. |
||||
|
Can hospitalized babies breastfeed? |
||||
| Children admitted to the hospital can absolutely continue their breastfeeding journey. It may look a little different than it did when they were at home, but we will work hard to make sure that we maintain the breastfeeding relationship. Sometimes, when your baby is admitted to the hospital, they may not be able to feed by mouth for various reasons depending on their condition. We will be able to continue our support during this time, and focus on maternal milk supply, pumping and oral immune therapy. | ||||
|
Non-Nutritive sucking |
||||
| If your baby is not feeding by mouth yet, it is important to create positive oral experiences for them. Providing opportunities for non-nutritive sucking such as a pacifier or soother, allowing them to nuzzle at the breast, or sucking on a clean, upside-down finger in their mouth to soothe all help create a positive oral experience for your baby. You can also gently stroke their cheek and speak to them when they are happy. Providing a drop of breast milk on their tongue, called Oral Immune Therapy and may be a positive oral experience that also allows them to smell and taste your breast milk while also providing them with antibodies from your milk. | ||||
|
Oral Immune Therapy |
||||
| Your breastmilk is like medicine for your baby, and it has many properties that help your baby heal, grow and fight infections. Even if your baby is not eating yet, or stops eating for some reason, they are still able to receive a drop of your milk every few hours until they are ready to eat again, we call it Oral Immune Therapy or OIT for short.
Your baby will receive a drop of your milk in their cheek every 2 – 4 hours and we will continue this practice until you are putting your baby to the breast or to bottle a few times each day. Only your own breast milk will be used for oral immune therapy. Even if your baby is receiving some donor milk (or formula) for feeds, we will only give your milk directly in your baby’s mouth. Even small amounts that you pump will be used to benefit your baby |
||||
|
Kangaroo Care or Skin to Skin |
||||
|
Kangaroo Care is the practice of skin-to-skin contact between infant and parent. As much as possible, we encourage all parents to provide kangaroo care which involves uninterrupted time for either parent to hold their baby skin to skin. Your baby will be in just a diaper and rest on your bare chest.
|
||||
|
Baby led cues |
||||
| To know when your baby is ready to feed, we will look for cues they are ready to feed. When the medical team has cleared your baby to feed, we will look for signs they are ready to feed such as sucking, rooting or opening their mouth, licking, or bringing their hands to their mouth. If your baby is sleepy, there are some ways of gently waking them. It might be necessary to try timing feeds with moments when they are already awake and keen to feed. With time, they will feel hungrier and be keen to feed. | ||||
|
Alcohol and substances |
||||
|
Mothers and their partners can receive conflicting advice from family, friends and health care providers regarding alcohol use and breastfeeding. The Public Health Agency of Canada and Health Canada recommend that you avoid drinking alcohol if you are breastfeeding, especially when your baby is very young. The safest choice is not to drink alcohol if you are planning to become pregnant, are pregnant, or are breastfeeding. However, you do not have to stop breastfeeding if you have a drink once in a while. An occasional small drink can be okay as long as you plan for it carefully. What does alcohol do to the milk supply? Alcohol decreases the letdown reflex and this could mean the baby gets less breastmilk during feedings. Drinking alcohol does not increase milk production. In fact, heavy drinking may decrease the milk supply. The younger the baby, the more immature his/her system, and the greater the difficulty in clearing the alcohol from his/her body. Limit alcohol intake, particularly when breastfeeding newborns (first 3 months). Mothers who drink heavily while breastfeeding put their baby at risk for poor weight gain, poor growth, and possible developmental delays Medications, alcohol and cannabis in breastfeeding (aboutkidshealth.ca) Very little is known about postpartum marijuana use and safety during breastfeeding initiation. The Canadian Pediatric Society and The Canadian Centre on Substance Use and Addiction discourage marijuana use during breastfeeding due to safety concerns related to adverse neurodevelopmental outcomes among breastfed infants. |
||||
|
Breastfeeding Positions (videos) |
||||
|
Breastfeeding log/pumping log |
||||
| If you find you are having difficulty remembering when you breastfed or pumped last, a pumping/feeding log is a really good tool to keep you on track. Some parents like to use an app on their phones, others prefer to have a paper method. | ||||
|
Engorgement |
||||
|
Breast engorgement is a common condition that many new moms experience, usually during the first few weeks of breastfeeding. Essentially, it's when your breasts feel overly full, hard, and sometimes painful. This can happen because your body is still figuring out how much milk it needs to produce for your baby. In the beginning, it might make more milk than your baby needs, leading to that swollen, tight feeling. Engorgement can make it a bit tricky for your baby to latch on properly because the breast is so full and the nipple might be less prominent. It's like trying to take a bite out of a firm apple. But don't worry, there are ways to manage it! Applying warm compresses and gentle massage or some hand expression before feeding can help the milk flow more easily, and cold packs after feeding can reduce swelling and pain. It's also a good idea to breastfeed often to keep the milk moving and prevent the breasts from getting too full. Remember, it's a temporary phase, and with a little patience and practice, both you and your baby will get the hang of it! |
||||
|
Mastitis |
||||
|
Mastitis is an inflammation of breast tissue that can include infection. Mastitis typically affects only one breast, not both. Symptoms of mastitis can develop quickly and may include:
The condition can occur when bacteria, often from the baby's mouth, enter a milk duct through a crack in the nipple. This can lead to an infection and the body's immune response causes inflammation. In breastfeeding women, mastitis can also result from milk staying within the breast tissue (milk stasis), often due to a blocked milk duct or problems with breastfeeding technique that prevent the baby from properly emptying the breast. Treatment for mastitis usually involves antibiotics to address the infection (if present), pain relievers to reduce pain and fever, and continuing to breastfeed or pump to relieve milk stasis. If breastfeeding, it's important to ensure proper latch and nursing technique to prevent recurrence. In cases where an abscess forms, surgical drainage may be necessary. |
Pumping/Milk Expression
We express our milk or “pump” to remove milk from the breasts using a breast pump or your hands! This milk can then be stored and given to your baby.
You may have to express your milk for many reasons, or your feeding goal could be to exclusively pump and provide expressed breast milk (EBM) with a bottle.
|
When should I start? |
| You can start pumping breast milk as soon as possible after delivery. If the baby is unable to breastfeed directly, initiating hand expression and mechanical pumping early will help establish your milk supply. If your child is currently unable to have oral feeds it is still important to start expressing milk to build your supply and be ready for when they do. |
|
Why is breast stimulation important? |
| After delivery there is a hormone shift, and the pregnancy hormones will decrease and the hormones that aid in milk production will increase. You can communicate with your body by stimulating the breast to increase those hormones and build a milk supply. Contrarily, if you do not stimulate your breast, you are communicating with your body that you do not need human milk for your child. This means frequent breast stimulation that mimics a newborns feeding schedule is key to success. |
|
How often should I pump? |
| In the early weeks postpartum, aim to pump at least 8-12 times per day, including at least once during the night, to establish and maintain your milk supply. This may seem like a lot, but the goal is to mimic a newborn feeding schedule which is every 2-3hours. As your milk supply regulates and your baby grows, you can gradually reduce pumping sessions as needed to meet your infant's supplementation needs. |
|
How much milk should I be pumping? |
| Every parent and baby duo are unique, so there's no one-size-fits-all answer. The overall goal is to be able to pump enough human milk to meet your child’s supplementation needs. The amount of expressed milk your child will need will vary based on age, gestational age, and medical considerations. Focus on setting up a routine for pumping and aiming to pumping every 3 hours. Pumping output can also vary depending on factors like time of day, hydration, stress levels, and breast health. Always remember that any amount of breast milk you can provide is beneficial for your baby. |
|
What type of pump should I use? |
| There are a few different options for types of breast pumps: electric, battery operated, wearable and manual. You can also get single pumps and double pumps. Electric pumps are typically recommended for regular use. They're efficient and offer various settings for customization. These pumps plug into an outlet and will have a better motor than any battery-operated pump. We would recommend a double electric pump. You can also consider renting a hospital grade double electric pump. These pumps provide the best stimulation for milk expression, especially for initiating and building a milk supply. Most insurance companies will reimburse the cost of a rental pump. Wearable and smaller more portable battery-operated pumps have been having an increase in popularity due to the benefits of being portable. These can be good options once your milk supply has been well established for occasional use but not for exclusive pumping or initiating and building a milk supply. Manual pumps can be useful for occasional pumping or when you need a portable option. Choose a pump that suits your lifestyle, budget, and pumping needs. |
|
Hands on Pumping: How to pump breast milk |
Remember, pumping breast milk can take time and practice to master, so be patient with yourself. Reach out to a lactation consultant if you encounter any challenges or have questions along the way. Your dedication to providing breast milk for your baby is invaluable and commendable. Keep up the fantastic work! More resources: |
|
Tips and techniques for hand pumping |
More resources: |
|
Engorgement Management |
|
Breast engorgement is a common condition that many new moms experience, usually during the first few weeks of breastfeeding. Essentially, it's when your breasts feel overly full, hard, and sometimes painful. This can happen because your body is still figuring out how much milk it needs to produce for your baby. In the beginning, it might make more milk than your baby needs, leading to that swollen, tight feeling. Engorgement can make it a bit tricky to pump properly because the breast is so full and the might have difficulty expressing milk. Pumps are great tools, however they work a little less efficiently when the skin is not soft and malleable. Don't worry, there are ways to manage it! Applying warm compresses and gentle massage or some hand expression before pumping can help the milk flow more easily, and cold packs after feeding can reduce swelling and pain. It's also a good idea to pump often to keep the milk moving and prevent the breasts from getting too full. Remember, it's a temporary phase, and with a little patience and practice, you will get the hang of it! |
|
Mastitis |
|
Mastitis is an inflammation of breast tissue that can include infection. Mastitis typically affects only one breast, not both. Symptoms of mastitis can develop quickly and may include:
The condition can occur when bacteria, often from the baby's mouth, enter a milk duct through a crack in the nipple. This can lead to an infection and the body's immune response causes inflammation. In breastfeeding women, mastitis can also result from milk staying within the breast tissue (milk stasis), often due to a blocked milk duct or problems with breastfeeding technique that prevent the baby from properly emptying the breast. Treatment for mastitis usually involves antibiotics to address the infection (if present), pain relievers to reduce pain and fever, and continuing to breastfeed or pump to relieve milk stasis. If breastfeeding, it's important to ensure proper latch and nursing technique to prevent recurrence. In cases where an abscess forms, surgical drainage may be necessary. |
Pumping while admitted to CHEO
Sometimes, when your baby is admitted to the hospital, they may not be able to feed by mouth for various reasons depending on their condition. We will be able to continue our support during this time, and focus on maternal milk supply, pumping and, oral immune therapy.
Every family that is admitted to CHEO will be provided one pump kit as needed.
|
What is included in your pump kit |
||||||||
|
Every family that is admitted to CHEO will be provided one pump kit as needed. The pump kit includes 4 flanges (x2 24mm, x2 27mm), 2 personal fit connectors, 2 valves and membranes, 2 tubing, membranes and caps, 2 30ml bottles with caps, and 2 80ml bottles with caps. Additional flange sizes and bottles can be provided as needed. Along with the pump kit, you will be provided with a mesh bag, a small bottle of dish soap and a basin to clean and maintain your kits between use |
||||||||
|
Where to pump at CHEO |
||||||||
|
When admitted to CHEO, there are several locations available to you to express your milk. If you are admitted to 4East or 5East, there are individual pump rooms located on each inpatient unit. Bedside pumps are available on request and subject to availability. If your baby is in NICU/PICU: There is a lactation room in the Ronald McDonald lounge (room 3521) on the 3rd floor of the Gary Cardiff Wing located between the two units. In the NICU, there are rolling pumps for you to use at your baby’s bedside. If you are admitted to the PICU, pumps are available on request and are subject to availability. |
||||||||
|
Using Medela symphony pumps |
||||||||
| “The Symphony hospital-grade breast pump with its research-based pumping programs has been developed specifically to support moms throughout their lactation journey: to initiate, build and maintain an adequate milk supply.”
The Symphony PLUS program card contains two different programs for the Symphony breast pump The INITIATE program mimics the irregular and more rapid sucking and pausing pattern of a term born infant during the first few days of lactation. This program is intended for use in the first few days after birth before secretory activation to support pump-dependent mothers to initiate milk production The MAINTAIN program is based on the 2-Phase sucking pattern of a term born infant during established lactation. This program is designed to optimize milk output after secretory activation to support all mothers to build and maintain lactation |
||||||||
|
Caring for your pump kit |
||||||||
| CHEO will provide you with one pump kit to use with our pumps while you are admitted. We recommend that pump pieces are washed with warm soapy water with every use and placed on a clean towel to air dry. You must sterilize your kit at least once every 24 hours.
If your baby is in NICU/PICU: There is a lactation room in the Ronald McDonald lounge (room 3521) on the 3rd floor of the Gary Cardiff Wing located between the two units. There is a lactation room located on the 5West (room 5078A, beside the play/family laundry room) for our families who are admitted to the medical-surgical floors to clean and sterilize the pump kits. |
||||||||
|
Caring for your expressed breast milk when your baby is in hospital |
||||||||
| Wash your hands with soap and water or hand sanitizer before pumping.
Always use approved containers to store breast milk. Leave at least ½ inch space at the top. Write the date and time of pumping on the label with a pen. Apply the CHEO label to the container vertically (as shown). Labels will be provided to you by your nurse. This milk can be used within 4 hours of being at room temperature. If the expressed breast milk is not going to be used immediately, store it in the refrigerator or freezer. Do not combine the milk from more than one pump session in the same container. Take enough containers for each pumping session home with you. Ask your nurse how much milk to store in the container Transport refrigerated milk in an insulated cooler with frozen gel packs or ice cubes stored in zip lock bags or a container with a lid. Transport frozen milk in an insulated cooler with frozen gel packs. Do not add ice cubes as they will draw the freezing out of the breast milk. |
||||||||
|
Breast milk storage guidelines |
||||||||
|
These are in hospital guidelines and will differ from home and community guidelines.
When labelling your breastmilk, please ensure to write the date and time it was pumped, the date and time it was frozen, and the date and time it was thawed. The staff at CHEO requires this information to ensure that your baby is given the best quality milk. |
||||||||
|
Troubleshooting |
||||||||
|
If you are having difficulty, we have collected some more resources to help CHEO children, youth and families troubleshoot any minor problems. If these problems persist or if you have questions and concerns, please contact the Lactation Support Team. If you are not admitted to CHEO, please reference the Community resource section below for further information about how to contact a lactation consultant near you.
|
Planning for home
|
Breast Pumps to purchase/rent for home use |
|
Medela brand double electric breast pumps to establish and maintain a breast milk supply. You can find these at:
Recommendation: Double electric breast pump that plugs into an outlet. There are many places across the city to rent a breast pump. To find a location near you that rent Medela hospital grade breast pumps, go to ottawabreastfeeds.ca |
Supporting families in CHEO's NICU
Every baby that is admitted to the NICU will receive a consultation to the Lactation Support Team. Whether your feeding goal is to exclusively breastfeed, combination feed, or wean, we will be able to support you through your NICU you stay, and follow-up as needed throughout your admission.
If your baby is not feeding by mouth yet, but you have chosen breastmilk feeding as your feeding goal, there are breast pumps at every bedside to help foster early expression and optimize breast milk supply.
If you do not have access to a breast pump at home, our lactation consultants can assist you in your search for the best fit for you. Rental pumps as available here: ottawabreastfeeds.ca. To support, and promote human milk feeding in the NICU, we offer loaner pump to families facing barriers to accessing a pump (such as inaccessibility to funding or a rental for a short period) with access to a hospital-grade double electric breast pump.
|
What is Oral Immune Therapy (OIT)? |
|
Your breastmilk is like medicine for your baby, and it has many properties that help your baby heal, grow and fight infections. Even if your baby is not taking food in their stomach yet, or stops eating for some reason, they are still able to receive a drop of your milk every few hours until they are ready to eat again, we call it Oral Immune Therapy or OIT for short. Your baby will receive a drop of your milk in their cheek every 2 – 4 hours and we will continue this practice until you are putting your baby to the breast or to bottle a few times each day. Only your own breast milk will be used for oral immune therapy. Even if your baby is receiving some donor milk (or formula) for feeds, we will only give your milk directly in your baby’s mouth. Even small amounts that you pump will be used to benefit your baby. |
|
Preparing Colostrum/Breastmilk for Oral Immune Therapy (OIT) |
| When you express milk for your baby, we will keep 1-2ml in a separate sterile container to use for OIT. This breast milk will not be frozen and will be used within the next 48 hours.
If you are in the unit when you express your milk, you or your baby’s nurse can give it directly to your baby. It will provide the freshest milk for your baby. The fresher the milk is, the more benefits it has. Your baby’s nurse will tell you when it is no longer necessary to separate your milk. |
|
More resources for families in CHEO's NICU |
|
Please visit CHEO's NICU family guide for more information about your stay |
Frequently asked questions
|
How do we consult the Lactation Support Team when we are admitted to CHEO? |
|
Just ask your care team (nurses or doctors) and they will be able to place a consultation. Our criteria is simple: if you have the capacity to make milk, we will follow your care. |
|
How soon should I start breastfeeding after childbirth? |
|
If you have experienced a delivery without complications, you should be given the opportunity to experience “the golden hour”, where baby is placed on your chest immediately after delivery. You should be given the opportunity to feed as soon as baby is showing hunger cues. If your delivery may not have gone as planned or if you are recovering post cesarian section, skin to skin and milk expression should be done at the earliest time that both mother and baby are stable enough to do so, ideally in the first 6 hours post partum. |
|
Is my baby getting enough? |
|
This video from SickKids can help you assessess your babies breastfeeding intake: Breastfeeding Intake Assessment - Part 1, How to know if a baby is drinking enough milk - SickKids |
|
How often should I breastfeed my baby? |
|
Breastfed babies feed on their own schedules. We call this baby led or cue led feeding. You will often find that breastfed babies wake every 2-3 hours to feed, however, it is normal to experience periods where baby will feed more frequently. This is known as cluster feeding. If your baby has high needs, is sleepy or it has been specified by health care providers to feed more frequently, we often recommend keeping baby to a 3 hour schedule to ensure optimal intake. |
|
How do I know if my baby is hungry? |
| When your baby is hungry, your baby will show different signs or messages that they might need to feed. We look for “early” hunger cues such as beginnings of wakefulness or squirming, opening their mouths, licking their lips or bringing their hands to mouth. If the baby starts to cry, or wakes up very hungry, this is considered a later hunger cue and may need some calming before attempting to feed. You can calm your baby by placing them in skin to skin with a parent or assisting with non-nutritive sucking on a clean finger or soother. Once the baby is calm, you may attempt a latch or offer a bottle. |
|
How do I get my baby to latch? |
|
Please reference the following video for latch assistance and positioning aids: |
|
When will my milk come in? |
| After birth, your body produces a very concentrated form of breast milk called colostrum. It is packed with all of the nutrients your baby needs in the first few days of life. You will only produce small amounts or even drops of this liquid gold in the fist few days. Most moms typically see their milk change from colostrum to breastmilk between day 3 and 5 of post-partum life. Sometimes it will change quickly, however some experience a gradual increase. Most moms will experience signs of painful or full breasts (called engorgement) and feel emotional on the day their milk comes in as it is a signs of your changing post-partum hormones. Do not fret is your experience is different than others, however if you have questions or concerns, reach out to a lactation consultant to guide you through it. |
|
Is it safe to buy breastmilk on the internet? |
|
At CHEO, we discourage the use of internet-based milk sharing sites and instead recommend contacting milk banks. Research has demonstrated that some milk samples sold online have been contaminated with a range of bacteria, viruses and pathogens, and medications not safe for the breastfeeding infant.
Donor human milk banks, where processed human milk comes from screened donors, have a long safety record in North America. All member banks of the Human Milk Banking Association of North America (HMBANA) must operate under specific evidence-based guidelines that require extensive testing and processing procedures as well as self-reported health information and a health statement from both the donor’s health care provider and the infant’s health care provider. Please refer to the following website to find a milk bank near you: |
|
Where can I find more information about breastfeeding for families living with HIV? |
|
CHEO follows the Canadian pediatric and perinatal HIV/AIDS consensus recommendations for families breastfeeding their infants who are living with HIV/AIDS. Our Team works closely with the Infectious Disease (ID) team to establish a plan and whether breastfeeding is a viable option for your family. The Team would need to assess whether the lactating parent's viral load is undetectable and has strict compliance with ART medications. For more detailed information on breastfeeding for families living with HIV, and to help you decide if you would like to continue to offer your milk to your baby, visit CATIE - Canada's source for HIV and hepatitis C Information. They have detailed information on HIV medication, medical appointments, breast care and more. |
Additional resources
|
General |
|
Lactation support |
|
Maternal mental health |
|
CHEO resources and care resources |
|
Milk donation |
|
Bereavement support & lactation after loss |