I have worked with 2 women whose babies would feed only in the side-lying
position, and even then were rather restless.  The first one would attend
her LLL meeting with a quilt so that she could lie down when baby wanted to
feed.  She was limited in her social life.

I had worked with her in the newborn period and knew of dairy allergies,
along with some other allergies.  When she called about the feeding issue
at around 4 months, I brought up the food sensitivities, and she assured me
that baby had outgrown them and she was able to eat anything she wanted to.
 I urged her to eliminate all of the "former" offending foods to see what
happened.  She was resistant, but finally agreed to give it a try.

After 3 days off the foods, baby was sleeping more peacefully, would nurse
on mom's lap as well as lying beside her, and feedings were quite peaceful.

So, when the second woman called with a similar problem I told her about
the first case and we talked about possible food sensitivities.  She had
never liked milk, so she was drinking soy milk with added calcium.  After
eliminating the dairy and soy foods, the problem was resolved.

>Baby seems to really want to nurse but pulls off and crys.

I find this often with food sensitivities. I think that it may be either
smell or taste that causes her to pull off, then go back because of hunger.

>Baby does spit up quite a bit. I observed baby
>fussing at the breast and baby pulls off too soon for it to be a strong MER.

Did mom ever have a problem with oversupply?  One of my cases had, and I
think that, even though it was no longer a problem, baby remembered that
lying down was the "safest" position. Also it might be over-active let
down, which surprisingly, isn't always connected to oversupply.  I have a
client now who has successfully reduced her supply and her milk still
sprays like a fire hose with the MER.

I would be cautious about working to reduce a supply in a 4 month old,
given the 4-month drop in milk supply problems. And I would not expect the
baby to suddenly decide she couldn't handle the oversupply. Has she fed
lying down from early on?

>There are no histories of allergies in the baby's family.

"History" can begin in any generation.  I don't rely too heavily on "no
histories of allergies" in determining whether "this" baby is needing to
have foods eliminated from her breastmilk. If mom relates dozens of
allergic relatives, then it is just easier to get her to look at foods as a
possible problem.

I think that it is an interesting pattern in these little ones.  Perhaps it
is related to congestion, or irritability in being held close in the
b'feeding position.

Patricia Gima, IBCLC
Milwaukee
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