Fertility: it's worth the weight....

Yes I know Miranda Kerr has had a baby and other supermodels have too, but something that I have noticed in my natural fertility practice is that it can be very difficult to help skinny women to conceive.

My definition of skinny is a Body Mass Index (BMI) below 19 or 20 as low body fat can cause low levels of gonadotrophin releasing hormone which can prevent ovulation. This lack of ovulation can cause some underweight women to have no periods, or to miss periods or to have a luteal phase defect - all of which can affect their ability to conceive both naturally and during IVF.

Fortunately, less than 5% of Australians are underweight and some may not need to gain weight if they are in good health. However, if you are struggling to conceive then I recommend that you try to gain some weight to reach a BMI of 19 to 20.

Poor diet, malnutrition, excessive exercise, eating disorders, low appetite and food aversions can all contribute to low body weight and infertility. If you feel that being underweight could be affecting your ability to conceive, then here are some healthy weight-gain strategies that you might like to try:

Choose more energy-dense foods (yes, the types of foods that people usually avoid when they are on a weight-loss diet). Go for high calorie foods such as full fat milk, avocados, nuts. High fat foods have twice as the energy of protein and carbs and will give you more calories. Although high-fat, high-calorie food is not healthy for most people, they may be essential for someone needing to gain weight. Choose healthy fats such as mono-unsaturated and polyunsaturated rather than saturated fats.

Regular meals daily make meals a priority and take the time to have a meal. Aim for three healthy meals every day and try to eat more food within the first 20 minutes of a meal - such as eating the main meal first and leaving the salad and soup for later.

Large portions you can eat more at each meal by adding extra food to your plate or an extra piece of cheese on your sandwich, having milk from a bigger glass and eating cereal from a larger bowl. Expect to feel full after every meal.

Extra snacks eat more frequently to increase your calorie intake by including snacks in between your main meals - snacking on dried fruit, nuts and seeds is an easy way to add calories.

Juice and milk these drinks are an easy way to take in extra calories - drink more fruit juice and add more calories to your milk by adding in powdered products such as Sustagen.

Exercise to build muscles to gain weight, go for strength training activities and increase your calories to support that exercise. The combination of strength training and eating extra food will help you to gain both muscle and fat. An extra 500 to 1000 calories a day above your normal calorie needs will be enough to support you during exercise and to build extra muscle.

Bon appetite!

Boobs and Booze: Is it okay for breastfeeding mothers to drink alcohol?

For the past 7 years, I have been group leader of the local mothers group as part of my volunteer counsellor position with the Australian Breastfeeding Association (ABA). This requires me to facilitate a topic of interest related to feeding or parenting once a fortnight.

At tomorrow's meeting, we will be talking about whether it is safe to drink alcohol when you are breastfeeding. The take-home message from this meeting will be that NOT DRINKING is the safest option but if we know the facts about how alcohol affects breastmilk, we can decide how to safely combine drinking and breastfeeding if we have a special occasion coming up or just want to enjoy a glass of wine with dinner.

Some of the facts that will be discussed are:

• How alcohol gets into breastmilk via your bloodstream and the fact that alcohol will be present in your breastmilk about 30-60 minutes after you start drinking.
• How much alcohol gets into your breastmilk depends on how much you weigh, how much you have eaten, how quickly you are drinking and the strength and amount of alcohol in your drink.
• The reason why time is the only way to reduce the amount of alcohol in your breastmilk and the "pumping and dumping" myth.
• What a standard drink looks like. As a general rule, it takes 2 hours for an average woman to get rid of the alcohol from 1 standard alcoholic drink (ie 4 hours for 2 drinks, 6 hours for 3 drinks and so on). This brochure issued by the ABA has a useful table which shows the approximate time taken for alcohol to be cleared from breastmilk. This table can help mothers to estimate how long it will take for their breastmilk to contain no alcohol.
• The Australian guidelines recommendation for all women (except when pregnant) is no more than two standards drinks per day. It is generally recommended that breastfeeding mothers can have up to 2 standard drinks (but not every day) once their baby is a month old (which is around the time that breastfeeding is going well and there is some sort of pattern to a baby's feeding).
• When feeding an older baby, who tend to have a more regular feeding pattern, it can be easier to time a drink so that the next feed will contain little or no alcohol. However, sometimes babies don't stick to their routine and may need extra feeds if they are unwell or "out of sorts".
• Drinking 3 or more standard drinks per day can be harmful to your health and your baby's health. Motor development skills have been found to be significantly lower in infants regularly exposed to alcohol through breastmilk (Little, 1989).
• Some ABA counsellors have reported instances of babies being drowsy and fussy after being breastfed by a mother who has had alcohol. Studies have shown that one standard drink changes the smell of breastmilk and has a mild sedative effective on the baby. A drowsy baby may not suck well which can lead to a reduction in milk supply. Any drug that causes drowsiness in the infant may be implicated in SIDS.
• Mothers who have been drinking often report a delayed let-down reflex and a perceived reduction in milk supply. They also report having a lower tolerance to alcohol which could be attributed to low oestrogen levels during lactation which can be associated with higher alcohol levels.
• Too much alcohol can impair the mother's ability to properly care for her baby, cause the baby to be slower to reach developmental milestones and decrease the flow of milk which can reduce supply.
• If you are planning a big night out and think you will have more than 2 standard drinks, you may wish to express and store some milk beforehand and arrange for someone who is not affected by alcohol to look after your baby. Do NOT sleep with your baby if you or your partner is affected by alcohol.
• We will also discuss some strategies to reduce the amount of alcohol in breastmilk such as breastfeeding your baby BEFORE you drink (and you know it will be a couple of hours before you are likely to feed again), eating before and while having a drink, as well as alternating alcoholic and non-alcoholic drinks.
• And, why it is better to give a breastfeed with a small amount of alcohol than to feed artificial baby milk (in short, the health risks of artificial baby milk outweigh the health risks of a breastfeed that contains a small amount of alcohol).

And what about the old wives' tale that drinking a dark beer like stout will improve your milk supply? What actually happens is that the alcohol in the beer stops the milk from flowing freely, causing it to stay in the breasts, giving the false impression that you have more milk!

If you are a breastfeeding mum or just plain interested in breastfeeding and want to come along to an ABA meeting, check out the ABA website for your local group's contact details.

Fussy eaters

A common concern expressed by parents at my clinic is how can they get their fussy child to eat a healthy and varied diet.

From 6 to 12 months this can be easy as babies are willing to try new foods, flavours and textures especially if you allow your child to play with their food. Forget the special pureed food, forget feeding them with a spoon (only to have them turn their head), let your baby explore, feel and play with their food and they will taste it and grow to love that food.

A few years ago, one of my clients told me she was worried that her 10 month old daughter wasn't interested in solids. She would refuse the food that her mother tried to feed her. After implementing some of the suggestions I made, this mum sent me a beautiful thank you card with this message:

"Dear Inez, Thank you so much for all your support. It seems my daughter likes the food that my husband and I eat more than something I prepare especially for her. She also loves fresh fruit more than stewed fruit. So I have decided to take it easy and am more relaxed about introducing solids than before. Thank you again for your kindness. My daughter and I have been helped so much by your advice."

So what were my suggestions that helped this 10 month old to eat real food? All I suggested was that she let her daughter play with her food and to spend meal times together as a family sharing food. I gave her Gill Rapley's BabyLed Weaning website which explains the concept including safety tips to prevent choking hazards. I also emphasised that eating together as a family encourages babies and children to try new foods. Babies tend to become fussy eaters if they have their meal on their own and away from the family table. They don't get to see the variety of food that their parents are eating which would normally make them interested in trying those foods.

The concept of letting babies touch and explore food as a way to introduce solids is not new and is something that families have been doing for a long time (especially when there is more than one child in the family and a lack of time to prepare special baby meals). Babies who have their first taste of food this way tend to eat a healthy and varied diet. It's not until the toddler years that they may start to reject new foods without tasting it. Don't you love those assertive toddlers that want to do everything themselves and do things their way?

Remember that toddlers learn by copying you, their siblings and playmates. They may start to reject new foods but this should pass if they see other people around them eating a variety of foods. Research has shown that you may need to offer a new food up to 12 times before a toddler will accept it. Avoid making food a battle but if food rejection is becoming an issue offer them a choice between two or three food options to appeal to their growing independence. If your toddler likes to help around the house, ask them to help prepare their own food as a way to encourage healthy eating.

Toddlers may be reluctant to eat well if they are tired, unwell or anxious, distracted by toys or a new environment, had enough to eat beforehand or filled up on too much juice or milk, and if there is no mealtime routine or the mealtime experience is negative.

If you want to find out more, the team at Embrace Holistic Services run fabulous sessions called FoodPlay that will show you a fun and positive way to help your child embrace new tastes and textures. Be prepared for a mess at these sessions but also be prepared to be amazed as you watch your baby taste food that they have never tried before or have rejected in the past. Bon appetit baby!!

For more information on introducing solids to your baby read my article here

Holding on: is your child afraid to do a poo?

Some toddlers can go through a stage where they refuse to pass a bowel motion. Initially, it can be due to a fear of making a mess but it can get worse as constipation sets in and the bowel motion becomes painful to pass which causes the child to hold in their poo even more. The good news is that this toileting problem can be treated with homeopathy.

The first time I came across this problem was when my son was 3 years old and he would scream and become distraught whenever he felt he needed to pass a bowel motion. His bowels motions then became so hard and large which made the problem worse because going to the toilet was excruciating for him. Like most parents with this problem I tried increasing the fibre in his diet, laxatives and reward charts to no avail. The only thing that worked for him was homeopathic treatment. The first remedy prescribed for him acted like a laxative which would expel the poo even though he resisted it. It wasn't until we tried him on a higher strength of the same remedy that the fear of passing a bowel motion resolved. He is now 12 years old and has never had a toileting problem since.

The reason why homeopathic treatment works for this issue is because it can calm the emotions and allow the toddler to pass a bowel motion without fear.

I recently treated a 4 year old girl who had developed a fear of passing a bowel motion for the past year. Her mother said the problem had progressively got worse and she is now holding on and refuses to pass a bowel motion to due intense fear. Over the past year they have tried suppositories, reward charts and increasing dietary fibre without success. She was even hospitalised after being constipated for a week and refusing to go to the toilet. As you can imagine, this problem was a great source of worry for her parents who had been trying everything to help their little girl for over a year.

Fortunately, within a month of homeopathic treatment she was able to go to the toilet with no problem and had become less fearful about things in general. Her father said he wished they had tried homeopathy in the first place.

So if your child has this problem, find a registered homeopath and give it a try. And don't give up if the first remedy doesn't help as it could take a couple of consultations to find a homeopathic remedy that will be effective for your child.