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underlying cause of the baby's symptoms is a disproportionate intake of
the low-fat foremilk, the milk that is made available to the baby early
in the feeding. When a baby consumes large amounts of this watery
foremilk and less of the fatty hindmilk, that is made available as the
feeding progresses, his stomach empties rapidly while at the same time
dumping excess lactose into the bowel. The result is many times like
that of colic in the baby.
Usually these symptoms can be relieved for mother and baby by making a
few changes in the nursing pattern. Start by making sure that you allow
your baby to completely finish one side before you offer the other by
waiting until he pulls off himself, goes to sleep, or ceases to
actively suck and swallow. Don't feel that you have to interrupt his
nursing on the first side after a certain amount of time. It is much
more important that he get the right balance of milk during the feeding
than that he nurse both sides. If after finishing the first side, he
does not want the second side, don't worry. He probably does not need
it. If you are uncomfortable, you can hand express or pump just enough
to relieve any pressure.
If this change in pattern does not bring about improvement, then it is
usually recommend that you limit the baby to one side for up to 2 -3
hours before nursing on the other side.
Some mothers with especially over-abundant supplies may have to go even
longer periods, nursing on only the same side. Again, if the unused
breast becomes uncomfortable in the meantime, you can pump or hand
express just enough to relieve the pressure. Nursing and pumping in
this fashion will help to regulate your supply to more closely match
your baby's needs within a few days and ensure that your baby gets the
right balance of foremilk/hindmilk. If after several days of limiting
your baby to one-sided nursing for a period of several hours, there is
still no improvement, you may want to try using an antihistamine,
drinking Sage tea, or applying cabbage leaves until you begin to see
improvement. (See the suggestions on our page about weaning
for more on these remedies.) Stop with these more extreme measures once
you notice improvement. Another last resort management suggestion is
the use of a silicone nipple shield used during the feeding to help
slow the flow of milk. Only use a nipple shield with the recommendation and observation of a lactation consultant.
Many times moms with overabundant milk supplies also experience
forceful letdowns. Their babies may cough, gag, gulp, etc. in the first
minute or so of the feeding as the initial letdown occurs. As mentioned
in the first paragraph, they may also pull off the breast repeatedly
and periodically refuse the breast. There may be some clamping down on
the nipple as the baby tries to slow down the flow of milk. Some babies
may try to perch out on the tip of the nipple rather than taking in a
good mouthful of breast tissue so that the milk doesn't flow so fast.
Both behaviors most likely will make feedings painful for mom. Babies
who react in this way may take in more air and will need to be burped
more often during the feeding. To help your baby deal with the fast
flow of milk, position him so that his head is slightly above breast
level. With a younger baby, the football hold works well in this
situation. Sit so that you are leaning backwards slightly, such as you
would while sitting in a recliner. This enables gravity to help slow
things down. You may want to try lying down on your back and allowing
baby to perch upon your chest as if he were nursing uphill or climbing
up your chest. You also may either pump or hand express until the flow
of milk slows down and then put your baby to the breast or you may wait
until letdown occurs and then take your baby off the breast while at
the same time catching the milk in a towel or diaper. Once the flow
slows, you can put your baby back to the breast. In time, with
maturity, your baby will learn to deal with the fast flow of milk with
more ease and will probably prefer it!
Written by Becky Flora, BSed, IBCLC
Last revision: December 11, 2000
Sources:
La Leche League's, "The Breastfeeding Answer Book" (1997) by Nancy Mohrbacher, IBCLC and Julie Stock, BA, IBCLC
"The Nursing Mother's Guide to Weaning" (1994) by Kathleen Huggins, R.N., M.S. and Linda Ziedrich
More Information at Other Sites:
"Finish the First Breast First"
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