Some answers to Christine directing attention to this mom's diet seem to
be off target, to me. From what I have heard and read, I believe it is
the PROTEIN from cow's milk that sometimes enters between alveolar cell
junctions to cause sensitivity problems in a baby, not the lactose in the
milk mom drinks.

This is what I wrote Christine Raasch:

<Sounds like foremilk/hindmilk imbalance, and a possible oversupply. Lots
in archives I bet. Kathy Dettwyler has explained it with "yellow and pink
balloons" as example of cream and foremilk.

First thing to try is having baby remove as much milk as possible from
first breast. I.E., perhaps 50% is removed before mothers who have been
told to use both breasts every feeding typically burp and switch.

If it has been 1 1/2 -3 or more hours since last feeding, especially if
mom has C,D,EE,HH etc. size cups, cream has had a chance to separate and
rise to top of tubings, so foremilk, with its lactose, is removed first.
Using second breast gives baby a heavier dose of lactose that it may have
enzymes to digest, and in the process, what she leaks, if she leaks, is
more creamy.

Have her put baby back on same breast at mid-feed, perhaps after breast
compression or massage, and with jaws at a different position and nurse
as long as desired. Hind milk will gradually get "let down" further, and
baby will get more cream, high calorie though less volume.

She can always use the second breast if baby still wants. Otherwise, let
it leak to comfort but try not to take more out so back pressure will
begin to balance the supply better in about 48-72 hours.

Some moms (the larger the breast) eventually do well feeding the same
breast for 2-3 or more feedings in a row before switching. E.G. Right
breast all morning, left breast all afternoon, right breast all evening
and left at night, switching to right half way through night is baby
wakes before a.m.

Had one mother I explained this to not long ago who decided to do like I
told her primitive agricultural moms in some places do - nurse
nondominant-hand side all day so dominant hand is free, then
dominant-hand side all evening and night. Said it was working like a
charm. Baby happy and content and she had balanced out supply to where
she had no leaking or overactive MER.

If this works, perhaps you can write up your consult in such a way that
this doc is "re-educated" about lactose, which is necessary for brain
growth. Makes one wonder about lactose free formulas and those babies'
brains!>

Jean
************************************************

K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA



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