Thanks to Dee and Laurie for your ideas regarding Mom's food/vitamin intake
-I am currently investigating these with her.

Barb Strange and Ann Perry responded with their concerns about encouraging a
Mom to "space" feedings. While understanding of the *generic* concerns of such
a discussion ie. we don't want the wrong conclusions to be drawn or blanket
reccommendations to be made, I provided very specific details to this case in
an effort to focus on the dynamics of this particular scenario, hoping to avoid
moving in this direction. Remember, in this case baby has been allowed to
feed as frequently as he desires around the clock. His CHOSEN feeding pattern ie.
very frequent during day (sometimes hourly or more) and less frequent at
night (every 3-4hrs) has coincided with a very miserable baby during
day/happy-night. After exploring MANY other options with a Mom who is not happy with the
above scenario, the choice of limiting the feedings and thus limiting the misery
(hopefully) seemed the sensible choice for the time being.
 Barb also wonders about how this baby is "put off" from feeding.   Mom
responds to him in the same way she responds at the end of the feeding when he is
clearly full or overfull (or any other time) and becoming fussy and
uncomfortable with obvious reflux etc. (but is still rooting!!) She tries a myriad of
soothing techniques including pacifier, swing, sling etc!
In terms of the generic management of OALD/overproduction, I do have some
questions. Because many of these Mom are particularly sensitive to stimulation,
can't we assume that the very frequent, snacking type of feeding pattern
perpetuates this tendency. While I'm very reluctant to advocate scheduling in any
way, I have had Moms who try every other measure to deal with overproduction but
its not until they choose to gently guide the baby away from sipping on this
foremilk throughout the day (when you talk about 2-3minutes of suckling on a
very full breast-this is the case!) that real inroads are accomplished in
diminishing production.   Last choice? maybe, but in multifaceted scenarios we
should be open to considering and discussing all of the options.

Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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