Mom has a 5 year old, a 3 1/2 year old, and 3 week old twins.  she called
me because she has mastitis, is on antibiotics.  i gave her info on how to
help relieve mastitis.  she has been nursing her twins on one breast each,
per day, then switching the next day.  she wanted to know if she should
just nurse on the affected breast, and i suggested perhaps nursing each
twin first on the affected breast, using the unaffected one as the second
breast until the mastitis is relieved - or else using the twin with the
stronger suck  on the affected breast.

The main thing she wanted to know, though, was the following:  her husband
has been giving the twins a bottle each of formula after the evening
feeding (or two) only.  she would rather not do this, but says after
nursing (at the same time) for an hour or more in the evening, there is no
milk (can't express any, babies fussy and unsatisfied) and she didn't know
what else to do.  her nominal question was should she avoid doing this
during her bout with mastitis.  i told her that the more time spent at the
affected breast the better, and that certainly the bottle(s) of formula
would decrease the time spent at the breast, so if she could figure out
another way, that would be great.  i offered to do some research and get
back to her about ways she might possibly increase her milk supply and meet
the babies' needs exclusively with breastmilk.  I suspected (and still do)
that her supply is fine, (she is nursing both twins every hour-two during
the day and every 2 hours at night.)  she was *very* intersted in avoiding
formula, so much so that i believe that she may have been interested in
that from the start, not just because of the mastitis.  i spoke with her
again and during our discussion, it became clear that she is too
overwhelmed with child responsibilities to consider pumping right now, and
i suggested that perhaps she does not have a milk supply problem afterall,
but that he babies are just fussy as is characteristic in the evening of so
many babies.  she felt certain they were still hungry, since they are
drinking 3-4 ounces of formula after nursing for 1-2 hours.  I suggested
that maybe it is more of a let-down problem, rather than a suppply problem,
as it would seem unusual for a supply problem to manifest itself at a
certan time of day every day.  she was receptive to this thought, and
together we concluded that it could be the added stress of dinner time, the
other children's needs, etc. that may be impacting her letdowns later in
the evening feedings.  We talked about her husband taking the twins out for
a stroll, or somehow changing their environment, to seee if the become
contented without more food (after nursing).   We also talked about ways to
stimulate her let-down.

The babies were born at 38 weeks, at good weights and good weight gain, so
their is not concern as far as we know (the babies haven't been weighed
since 5 days old - they will have their one month visit next week).  But
toward the end, she mentioned that they are "constipated".  I am not clear
on whether this is true constipation (hard, dry, painful), or just
infrequent stooling (but hte babies are only three weeks old, so this too
would be a concern).  She said the often skip several days between bowel
movements.

I know the normal range is 2-5 per day for an exclusivelyu breastfed baby.
She started giving (her husband did actually) one bottle of formula in the
middle of the night at 3 days old, on her pediatrician's advice (ostensibly
to prevent premature weaning because of exhaustion).  She discontinued
these iddle of hte night bottles a week ago, when she got mastitis, but
that is when she started the evening formula.  So  my question is - could
it be the formula that has been causing infequent stooling/constipation -
or is it, as her pediatrician suggests, a sign of insufficient milk?  What
is the standard for breastfed babies who receive some supplemental formula,
as far as stooling pattern goes?  One twin uses a pacifier  - but a very
little bit - minutes at a time 2 times a day, and the other twin does not
take one.  No solids, water, or other supplements, besides the 1-2 bottles
of formula per day.  Any suggestions welcome/very much appreciated - about
hte stooling, the milk supply, the inhibited letdown theory, or any of it!
Thank you all.


Lyla W.
La Leche League Leader - Oakland/Berkeley
[log in to unmask]