Category Archives: Gear

Q&A: pain relievers for teething

Amy writes:

"You mention in your supplements for pregnancy post that you are not much of a pill-popper, and in fact have been working on the same bottle of ibuprofen for 5 years (I paraphrase). So I respect your reluctance to overmedicate and with that in mind I pose this question:

What are your feelings on Tylenol and Motrin (or acetaminophen and ibuprofen)? Here’s the true-life scenario playing out at our house this weekend: Baby, almost 7 months old, has her first  I-don’t-know-what. Cold? Some congestion, some wet-sounding coughing, some fussiness. Last night her normally stellar sleep habits were all out of whack and we had to drive her around in the toasty car to get her to sleep. (Usually she’s down at 7 easily and sleeps until about 5 or 6. We are lucky in that regard.) She doesn’t have a fever, but she is cutting teeth. Knowing how much longer than usual it took to get her to sleep last night, I went ahead and gave her a dose of Tylenol before putting her down tonight. She cried in a lackluster way for about 10-15 minutes, and then went to sleep.

The other day I mentioned having given her Tylenol for teething pain to an acquaintance (yes, we use Hyland’s gel too). He smiled knowingly and said "Ah, liquid sleep!" I try not to feel defensive about parenting stuff, but I confess I felt a twinge of guilt when he said that, and he wasn’t even saying it in a disapproving way. It’s just that I suddenly wondered if I am too quick on the trigger, or dropper rather. Your thoughts?"

I have this thing about informed constent. I just don’t think I have the right to do something painful or permanent to a person without their informed consent unless there’s a clear, definite reason for doing it. This is why I’m anti-circumcision for my own boys–there was no way they could consent, and they certainly couldn’t be informed. (They can do what they want to when they’re old enough to understand and consent, and it won’t be my business.)

Pain relief falls under that same idea for me. I don’t take anything for my own pain very often, but I don’t think it’s fair to deny pain relief to someone who can’t ask for it in any way except by crying. If there was overwhelming evidence that the dangers of Tylenol and Motrin were huge I’d reconsider, but they’re both generally safe in the small, infrequent doses that a baby gets during teething. So I definitely use them when my kids are having a particularly rough time.

I do try other things, though, first. I use a lot of homeopathic remedies (my kids’ pediatrician is an MD and also a homeopath) and usually try either Humphreys #3 pellets (in a sugar base; you can get them OTC for around $5 from a pharmacist, who can special-order them for you and they should come in within a day or two) or Hylands Teething Tablets (in a milk base; you can get them for around $5 at a natural foods store). I’m not a fan of the Hylands Gel, which has been worthless for my kids. The homeopathic remedies are great at easing the crankiness and restlessness of teething, but they don’t do much for the really painful nights.

Our pediatrician told us to try to avoid Baby Anbesol and Oragel, because even the baby formulations can be too strong and can kind of burn the gums (like a frostbite kind of burn).

I’m really not crazy about baby Tylenol because I don’t want to give an infant the artificial flavors and colors. Plus it’s hard to measure out in the middle of the night, and they always end up spitting out half the dose. So I was thrilled to discover acetaminophen suppositories. No artificial colors or flavors, no measuring, and they get the full dose. Just remember to keep them in the refrigerator so they don’t melt all over.

I wish I could find ibuprofen suppositories, because the ibuprofen works so much better, and I hate the fake bubble gum (for babies?!) flavor.

So that’s what I do for teething.

It sounds to me like all her problems are symptoms of the teething. Some common symptoms of teething are:

* biting hands or anything that comes near their mouths
* crying out in yelps of pain
* drooling
* runny nose or congestion from drooling
* "smokers’ cough" from the drool going down the back of the throat
* spitting or throwing up from drool going into the stomach
* "drool stool," which is shards of drool in the poop (I know, and it’s truly stunning when you see it)
* rash around the mouth
* rash around the anus
* acidic poop (sometimes you can even smell the difference) and a burned monkey-butt look after pooping
* tugging or pulling at the ears
* not wanting to nurse
* biting while nursing
* flash fevers (fevers that come out of nowhere and are gone in 30 minutes to an hour)

Are there any I’m forgetting? Some kids never have any of these symptoms, some have a few, and some lucky children (like mine) have all of them. The congestion and cough sound like they could be from the drool. I hope her teeth come out quickly and she (and you!) gets some peace and sleep, and that the poor little thing stops crying "in a lackluster way" (which gave me a mental image of Simon Cowell telling her she has a beautiful voice but he just didn’t believe the crying, and she needs to work on "connecting" to the crying more for next time).

Q&A: toddler with a pacifier

Dorie writes:

"I have a 16 month-old daughter and I am thinking about weaning her from her pacifier. She only uses it when she’s sleeping, maybe on long car rides, and if she’s teething or doesn’t feel well. The rest of the time she’s fine without it. The only advice I can find about this pertains to infants who awaken during the night and cry for their pacifiers. Is it hurting anything to continue letting her use it? Do you think it will be easier to take it away now or later? Also, any idea how I should go about doing this? I’m hoping you have experience with this."

Time for full disclosure here: I sucked my thumb until I was, um, 11. Years. 11 years old.

My mom figured if I was having my emotional needs met, then I must just need to suck, and she shouldn’t try to stop me. I weaned myself from nursing, but kept on sucking my thumb. When I went to school I figured out immediately not to do it front of other kids, so I only did it at night before I went to bed. My teeth were fine (until a genetic tooth size problem that my brother, mother, and two cousins–none of whom sucked their thumbs–also have caught up with me and I got braces last year) and I never had any anxiety-related problems or other issues. FWIW, my orthodontist (who is quite well-respected) says that she doesn’t think pacifier use or thumb-sucking does anything to your teeth unless you’re doing them for hours each day.

My first son used one from 3 months to 8 months, and my "technique" for taking it away was that I forgot to bring any when we went on vacation and by the time I had a chance to get out to buy a new one he’d forgotten about them. (I highly recommend ineptness as a parenting technique.)

So my answer to you is that you should take it away if you want to, but if you don’t feel the need to now, don’t worry about it. It sounds like your daughter has a pretty good handle on her own emotional limits and uses it only when she really needs it, so you’re not going to have that "4-year-old with a pacifier in her mouth constantly so you can’t understand what she’s saying" syndrome anyway. A 16-month-old is still a baby, and I’m guessing that having the "home base" of the pacifier is probably a good disciplinary tool to help her calm down so things don’t devolve into bad situations when she’s overtired or feeling crappy.

I don’t know anyone who got rid of the pacifer at that age without a fight. It seems like it’s easier to do earlier (when you substitute something else) or once the kid is 2 to 3 years old. There are two techniques for giving up pacifiers after the age of 2 that have worked well. The first is to let the kid buy something s/he really wants with the pacifiers. You call the store ahead of time and give your credit card number (or make other arrangements for payment), then the kid comes in with a bag full of all his or her pacifiers, and gives them to the clerk to pay for a new Thomas set or dollhouse or whatever. Then later if the kid asks for a pacifier, you can remind the kid that they bought the new toy with them, and if they want the pacifiers back they have to return the toy.

The other technique requires knowing someone who’s having or adopting a baby. You tell your child that the new baby needs pacifiers to suck, and big girls/boys don’t need pacifiers, so let’s give your pacifiers to the new baby who needs them. It might take a few days of negotiation and discussion to get the child to agree to give the pacifiers. Then you wrap up the pacifiers as presents, and give them to the new baby (obviously the new baby’s parents need to know ahead of time that you’re giving a bunch of used, toddler-sized pacifiers!). If the child asks for the pacifiers later, reinforce what a loving gift it was to give the pacifiers to a baby who needs them, since your child is a big kid who doesn’t anymore.

Both of these methods recognize that pacifiers aren’t just physical tools, but are also emotional comforts that kids grow out of. Giving them to younger babies or using them to buy a new toy are ways of marking the passage from baby to "big kid" and give your child a measure of control over quitting that are more respectful than just saying "no more pacifiers!" and taking them away. I don’t know if there’s an easy way to do that with a kid under 21 or so months, and to me it doesn’t seem worth it to jump through a bunch of hoops to get rid of a pacifier (the way it would to do something like nightweaning, which has an actual effect on the mother’s emotional and physical state).

The bottom line is that for me, it wouldn’t be worth it to try to take away the pacifier right now, and I’d rather not lose that tool in the anti-tantrum arsenal. It seems like one of those parenting issues that people get all het up about, but really, doesn’t everyone with a 16-month-old have bigger fish to fry? But if it’s just really nagging at you and you’re dying to get rid of it, give it a try and see what happens. If it works, let us know and I’ll post your results.

Q&A: what to bring to vacation with a baby

Shandra writes:

"My husband and I have a 6 month old, and we’re going to a (winter climate) resort in March for 5 days. They’ll provide a crib, which I think will be okay even though he sleeps in a co-sleeper, because we can push it up against the bed.  I breastfeed, but he’s started some solids – whole grain cereals so far, but by then I expect some fruits and veggies in as well.

My questions are, what should I know about travelling with a baby? Is there anything we can do to prepare? What gear is indispensible and what can we leave behind? We have a Honda Civic so the space question is a big deal. We haven’t gone anywhere since having our boy."

I read somewhere that there are two kind of New York City mothers–those who pack everything they could possibly need, and those who pack almost nothing, knowing they can buy whatever they need on the way. I’m the second type, so I tend to pack only the bare essentials.

Since you’re able to drive to your vacation destination, I’m assuming you’re staying in an area that’s going to have the same sorts of products you usually use at home available to you. (Did that make sense? All I meant was that you probably won’t have to hunt down things in a foreign language.)

Your big areas are, as always, sleep and food. It sounds like you’ve got the sleeping thing covered, and the feeding thing should be fine as well. If you use jarred food, just make sure to bring enough along. If you do mostly mushed table food, you’re still set.

The rest is all gravy. Depending on what you’ll be doing you’ll probably want to have a sling or other carrier for him. You may or may not need a stroller, depending on where you’ll be walking (and if you’ll be walking). If you’ll be doing hiking or cross-country skiing or anything rugged like that you may want to borrow or buy a good backpack to put him in.

Are you going with just the three of you, or will you be with other people? If you’ll be with others, you’ll probably play a lot of Pass The Baby, so you’ll hardly have to pack anything to entertain him. If not, you may want to bring the smallest toys that entertain him the most. In other words, no to the exersaucer, but yes to the Skwish. I’d also leave behind the swing or bouncy seat. If he’s not used to tummy time, now’s as good a time as any to let him get some, because a blanket’s easier to pack than a seat is.

If you have a portable high chair (like the kind that hooks to a table) you could bring it, but I’m guessing at a family resort they’ll have high chairs. You can stick your diaper bag behind him in the high chair to stabilize him.

Bibs, wipes, diapers, baby soap, clothes, nail clippers(!), baby Tylenol, teething tablets, butt cream, lovey. If he’s crawling, bring along a pack of outlet protectors. Toss a roll of duct tape in your bag just in case.

If it was summer I’d mention sunblock, and if you were going on a plane I’d remind you to bring the carseat, but you can’t forget that on a car trip anyway.

I can’t think of anything else that you couldn’t easily get on the road. Someone will remind us if I have.

IME, if you can maintain the same bedtimes and naptimes (within reason), things should go really smoothly, because this is the perfect age to travel with a baby. Have a great trip!

Potty Training: peer pressure

SarahA writes:

"My daughter is 18 months old,
and although I had no intention of starting to potty train her this
early, it looks like we’re into it.

For
about a week, she’s been sitting on the potty at daycare, where two
older girls (both 24 months) are being trained. The daycare provider
says my daughter just wants to do what the big girls are doing, and she
seems to be more into it than the other two. She has yet to pee or poop
in the potty, but sits there whenever the other girls do. Over the
weekend, we were at our friends’ house, and their daughter, who is 16
months, had a potty chair. My daughter got very excited about the chair
and played with it all night. So I picked one up for her.

Since
Sunday, when I brought the potty chair home, she has been carrying it
around the house and sitting on it all the time. Sometimes she wants
her diaper off, but mostly she’s fully clothed when sitting on it.

I’m
wondering if it’s ok to let her play with the potty, since I have no
intention of pushing the issue right now. If she asks for her diaper
off, I oblige, but I don’t encourage her to sit on it, or to remove her
clothes before she does. Is this ok? Should I be letting her play with
it like it’s just another toy?"

Why not? I think you should just go with whatever she’s showing an interest in doing with the potty, and soon she’ll be peeing in it. Whatever makes her want to spend more time with it is fine, IME. In a few months you might want to push it a little by taking off her clothes (once the weather gets warmer!), but for a kid that age potty love is a good thing in and of itself.

Your email brings up another great potty training technique, which is to use peer pressure to get a kid interested in training. It’s amazing how much toddlers and preschoolers want to be like each other and do what the other kids are doing. (OK, maybe not so surprising, considering the popularity of things like Von Dutch hats in 2004 and those I-Pod onesies in 2005) You can leverage your kid’s desire to be like the "big kids" into an easier time potty training.

If your kid has a friend who is trained or further along in the process, try to arrange for the two of them to spend as much time together as possible for a few days. Whenever the other kid goes to the potty, let your kid go, too. Whatever kind of underpants your child’s friend has, run out and buy them. (Even if you’re a dyed-in-the-homespun-wool anti-licensed-character-consumer, Bob the Builder or Dora underpants can be your friends.) Make sure your child has a potty at home. Start talking about using the potty, and talk about how the friend can do it and "soon you’ll be able to do it, too!"

How susceptible your child is to peer pressure in pottying depends on his or her personality, obviously, although I don’t know if it necessarily translates into susceptibility to peer pressure in other areas. My aunt told me the possibly apocryphal story (it happened 25 years ago) of how my very counter-culture, headstrong, road-less-traveled cousin potty-trained. My aunt sent her over to play with the neighbor girls one day when she was around 16 or 17 months old. When my cousin came back 4 hours later she was potty-trained. The girls next door had learned to use the potty, and she just decided to do it with them.

So you never know. But if the rule for dressing for career success is to dress for the job you want to have, not the one you currently have, then the rule for potty training is to hang out with the kids who go the way you want your kid to go, not the way s/he currently goes. Hooray for your daycare providers for encouraging your daughter. Good luck, and start looking for cool underpants.

Q&A: getting a 4-month-old baby to take a bottle

Melissa writes:

"I am currently breastfeeding a 15 week old baby. We would like to give her breastmilk from a bottle, but so far we haven’t had a lot of luck with this.

We waited until she was about four weeks before trying and had some luck getting her to drink about an ounce, but we didn’t really keep in her "practice". Now she will put the nipple in her mouth but won’t suck on it.

We have tried all imaginable bottles and nipples. Some seem to be a little better than others, but none markably so.

I am going to return to work at six months; at the same time I’ll be introducing her to solid food. I really don’t want to do that sooner and I’d to send her with breastmilk in a bottle.

ANY ideas for helping my baby take a bottle? Brands, technique, persistance, anything?"

Well, I’m 1 for 2. My first child took a bottle easily (on the second try, at 7 weeks) and my second wouldn’t take a bottle (we started trying at 2 weeks and gave up trying at 9 weeks) until he was around 5 months or so. And he’ll only take one from our babysitter–not from me ("Are you freaking joking me, lady?!" is what his eyes say) and not from my husband ("Nice try, hairy person, but I prefer to wait for the smooth one with the milk") and not from my mom ("I like you so I won’t cry very much as you rock me, but I think we can be honest about the fact that both of us hope the lady with the milk shows up soon"). And I think he only takes it from her because he loooves her and is trying to flirt. So I’ll tell you what I know, but it may not be any more revelatory than what you’ve already been doing. Let’s hope one of the readers has the magic bullet and will post it.

Here are the basics of what I was told:

* Do not wait until your baby is really hungry to give a bottle. The baby should be interested in the milk, not desperate for it. A hungry baby will become an angry baby, who will reject anything that isn’t the norm. Nurse your baby to take the edge off and then try a bottle, or try a bottle an hour or so after your baby has eaten so s/he will be interested but not too hungry.

* Have someone who’s not the nursing mother give the bottle. Why would any baby accept milk from a bottle when warm, snuggly, good-smelling mom is right there? Instead, have your partner or someone else give the bottle. Some kids will accept a bottle from someone else when the nursing mother is still there but in another room, but others won’t take one if the mother is anywhere in the house. The nursing mother may have to leave (go get a pedicure! or read a magazine all by yourself! or drink a latte!) while someone else gives the bottle.

* Keep it fun. Even though you’re desperate for your baby to take a bottle, the baby will be more into it if it’s just a fun game. No pressure. Just dripping a little milk onto the baby’s lips, then teasing with the bottle to get the baby to try it. Eventually the baby will probably have a lightbulb "Hey! Milk comes out of this thing, too!" moment and the objective will be achieved. We hope.

* Some babies don’t want to take a bottle, but will take another kind of cup. Try the Nuby cup or straw cup or sippy cup (with the valve removed, if the baby is under a year or so). Read the comments to this post, which have stellar suggestions from readers about what worked for their kids.

Now that I’ve regurgitated the same stuff you’ve heard a million times, I’m going to go a little radical and tell you I think you should not try to make the experience of taking a bottle of breastmilk anything like actually nursing. By the time you go back to work you won’t be dealing with a teeny newborn. You’ll be dealing with a 6-month-old who will be getting curious and excited about different textures and flavors and experiences. If you can make drinking milk a new and interesting experience that isn’t connected to you (since it’ll be the daycare provider giving it to her), you might have better luck getting her to take it (since she sounds like one of those babies who doesn’t want to be "tricked" into drinking milk from something other than the breast). So it might be worth it to try giving her cold breastmilk out of a straw cup or sippy (or the Nuby if she won’t do a straw or sippy). 6 months is kind of a transitional time in a lot of ways, and some kids who are very particular about what goes into their mouths before then get more adventurous for a few weeks right around that time (which makes sense, since that’s when kids start to want to eat other foods). You might be able to use that in your favor to get her to drink cold milk out of a different kind of cup.

If you decide to adopt that approach, you might want to wait another month or two before you even try to introduce milk in a cup or sippy. That way you can be closer to the experimentation window and not spend time trying to give warm miilk from a bottle in case you end up giving cold milk from a cup later. But obviously it’s your call, based on what makes you feel better about things.

If nothing works, I think you have two options:

1. Let the daycare provider deal with it. Your daughter won’t be the first child they’ve ever dealt with that doesn’t want to drink out of a bottle. They probably have tricks we don’t know about.

2. Don’t worry about it. A 6-month-old can go a long time between feedings, and she may just rearrange her feeding schedule so she eats only solids at daycare and does all her nursing at home. This wouldn’t surprise me at all, since I know plenty of babies who are at home with their mothers who hardly nurse at all during the day, but eat food during the day and do most of their nursing in the evening and the 11 o’clock "dream feed." So I think it goes hand in hand with the age of exploration, and is quite a handy way for a baby who doesn’t like bottles to still get in enough calories while still not taking a bottle.

Good luck. I think it will end up being much less stressful at 6 months approaches than it is now.

Q&A: breast pads (specifically Lilypadz)

Daphne (who is newly pregnant and either a market researcher or product liability lawyer, judging from her questions) writes:

"So. Lilypadz. Any specific feedback you can give me that would be enlightening? 

How long have you been using them? Months? A year? 2 Years?

What are they made of, by the way? Plastic/silicon/latex/NASA-developed secret substance?

How many pairs have you gone through? 

What color are they?

Are they detectable through clothes? 

Speaking of clothes/foundation garments… if you’ve used the Padz for a long time… do you NEED a nursing bra? Or can you use a normal bra at some point?

Have you had success with wearing them to bed minus the foundation garment?

Did you use them with the prior pregnancy? 

What are the noticeable differences between the Padz and antique padded
milk-absorber thingers (if you ever used the old fashioned ones)?

Do they still stick if you use ointment to preserve the integrity of the skin (cracking/chapping/etc)?

Anything else you can tell me that I might not think to ask you would also be most helpful.

Earlier tonight, my sister in law complained that her old-fashioned breast-leak-preventers were horrible.  So not only would I like to get some for me, but I’d like to get SIL some ASAP. "

That is a thorough line of questioning, Daphne. I hope never to be up against you in a courtroom.

I was told, in the breastfeeding class I took while pregnant with El Chico, that the reason some women leak is because there’s a muscle inside each breast that controls the flow of the milk. Some women have tighter muscles there (they won’t leak) and other women have looser muscles there (they will leak). The LC who led the class did not think supply was directly correlated to whether or not you’d leak (although obviously if you have chronic low supply you won’t ever get engorged enough to have anything to leak).

The difference in muscles (which apparently has some genetic component) also has something to do with the different ways women experience the sensation of milk letdown. I’ve heard some women describe it as painful, like little electric shocks, while others say they never noticed it, but most seem to feel something in between.

Also, the longer you nurse, the better your body becomes at storing and regulating supply, so the less you’ll get engorged and the less you’ll leak. All this stuff make sense to me, based on what happened to me and the women I’ve talked to about this. I stopped leaking with El Chico at maybe 4-5 months, and with El Pequeño at around 7 months. I stopped feeling the letdown with each kid right around the time I stopped leaking. I have a friend who had a huge supply (her daughter had a heart defect that caused her to need an enormous number of calories for the first two months until the hole closed up) but never leaked. I have other friends who leaked until they weaned.

So you don’t know ahead of time whether or not you’ll leak and even need nursing pads, although if you leak during pregnancy you know you’ll leak at least some once your milk is in.

And now a little review of the nursing pads I’ve tried. I’m an oversupplier, and I leak. Waking-up-in-a-puddle-of-my-own-milk kind of leaking (a problem I know tons of people would love to have even if it means you smell like a cheese factory). So nursing pads aren’t optional for me (my mom says she used to just put a cloth diaper in each side of her bra).

I’ve used disposible pads, and really really don’t like them. They are convenient, except that I always run out and then by the time I get to and from the store I’ve leaked through my bra and shirt. The adhesive never really works that well so I end up with a bunched-up pad that looks like a boll weavil in my bra and is not giving me proper coverage. They’re not absorbant enough to cover me for all night. The stay-dry material of the pads always makes me itch. And if you aren’t careful to buy disposible pads that breathe you can get a wicked infection or fungus, which just, eew.

I’ve used cloth pads and like them slightly better. They’re far more comfortable, and it’s not throwing money down a hole because you can reuse them. But I have to change them 3-4 times a day, they bunch up and are bulky even when they’re not bunched, and I have to remember to wash them and somehow keep track of the pairs (yes, I use a lingerie bag, but somehow they escape). Also, they don’t contain my nighttime output.

I struggled through with the cloth pads during my leaking time with El Chico, but lost all patience when I was leaking with El Pequeño. So I gave in to the hype about Lilypadz (despite my misgivings about purchasing a product with a Z where an S should be). Oh, so worth the $20. So, so worth the $20.

Lilypadz are clear, floppy, flower-shaped discs made of "silicone rubber compounds" that are smooth on one side and tacky on the other side. You peel them off the hard plastic discs they come on and stick them right to your skin, like pasties (link is not work safe, no no no!). They work the same way it does if you press your fingers or the back of your hand against your nipple when you feel the letdown coming–the pressure stops the milk from coming out. So Lilypadz don’t catch any milk; instead, they stop it from coming out to begin with.

Because they stick to you you don’t need to wear a bra with them (I didn’t at night), and because they’re so thin and flexible you can’t see them under clothes. A friend with no kids told me that her friend (also with no kids) wears them under skimpy outfits to prevent nipple show-through. For what that’s worth.

After you wear them you should wash them with soap and let them air dry. If you don’t wash them in between wearings they won’t stick to you that well (and milk can come out and leak down out the bottom of them). Whenever you want to you can boil them to sterilize them (boiling them turns them a little cloudy, but doesn’t affect the performance). After a couple of months mine started to disintegrate slightly. I used mine for about 3 1/2 months, at which point I stopped needing to use them (I stopped leaking) and stopped keeping track of them and one went missing (it’s undoubtedly back behind the headboard of our bed, where I can’t see or reach). The website says they last for around 4 months, which I think is probably a good estimate.

From a financial standpoint, they’re way cheaper than using disposible pads for the same amount of time. In order to have a decent rotation of cloth pads you’d probably end up spending at least $20, so you end up ahead there, too. Environmentally speaking, I liked only having two items in use that required minimal care.

The website claims that they are less likely to cause thrush than other pads are, and that makes sense to me since the milk shouldn’t even come out to get trapped next to your skin. I didn’t use mine until I was past the irritation phase of nursing, so I don’t know how they’d perform with lanolin underneath them. I’d recommend that in the first few weeks of nursing, if you’re using ointment for irritation or cracking you allow your nipples to be in the open air as much as possible anyway, so pads shouldn’t be an issue at that point.

For me at least, Lilypadz were absolutely the answer to the question "If they can put a man on the moon, why can’t they invent nursing pads that don’t make me look like an idiot and smell like a fine Stilton?".

Oh, and I have problems nursing while not wearing a nursing bra because I have a big cup size. Friends with smaller cup sizes have great success just lifting their regular bras to nurse. So the question about whether or not you need nursing bras totally depends on the size of your particular rack. You may want to check out this post about nursing bras, and especially the comments, to gather some more info about nursing bras in general.

I hope that answers all your questions, because my brain is empty now on the topic of leaking and breast pads.