In working with gassy babies, especially those gassy from early on, I've often found that these babies are getting mostly foremilk and relatively little of the higher fat hindmilk. This is especially true when "experts" have told the mom to only nurse for short periods of time. Let's go back to the biology. Primitive cultures have moms typically wearing their babies as they go through their days. The baby nurses often (q2/hr or more), but usually from the same breast repeatedly because it's too much trouble for mom to stop her work and rearrange everything to switch sides. She switches when either the baby indicates he;s not happy with the amount or flow rate on side one anymore, or when she begins to get uncomfortably full on side two. These babies get plenty of cream to grow on. The higher fat content also (if I remember my studying this correctly) has a modulating effect on the rate at which the food moves through the gut. Higher fat content moves more slowly. Slower process allows more time for the cells lining the gut to produce lactase, the enzyme that appropriately breaks down lactose, the sugar in milk (all mammalian milk) releasing energy for growth. Less sugar left in the bolus of food as it travels down the GI tract means less breakdown into methane and other gassy substrates by the bacteria in the lower reaches. (bread dough rises because of the gasses produced by yeast organisms breaking down sugars - not quite the same, but similar process.) Soooooo, empty the first breast first. As toddlers are often snackers due to their short attention span and desire to get back to all the new things they're learning (they already know about the breast), and we are conditioned to switch sides each time, these guys often get the foremilk from one side, then the foremilk from the other, and so on. I believe I learned that the higher fat content of hindmilk is caused (in a VERY simplistic way) by the contraction of the network of fine muscle cells around the alveoli causing letdown, pressing more fat through into the milk. The baby has to nurse through all the foremilk that accumulated between feeds to get to the hindmilk that is made mostly during letdown. So short-nursing toddlers may never get to it. Block nursing could be a real help here.
Related issue, without a creamatocrit, for babies with slow gain or very sleepy babes who won't stay awake long enough to get to the hindmilk, I have sometimes suggested that moms express (by hand or pump) the milk remaining (especially from the first side) to get the really creamy stuff, then feed it by teaspoon (skimmed off the top or the whole thing depending upon volumes) when they observe the baby's first cues for the next feed. This doesn't work so well when the baby has gotten frantic, so having someone other than mom (show should be sleeping in the early days) observing cues can be big help. No real protocol here, just some (I think) common sense.
Best wishes to all.
--
Kay McKee, IBCLC
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