Mellanie,

Here are my thoughts on your case. First, sometimes oversupply/OMER can
persist for more than the early weeks. This sounds like the first thing to
pursue. The dairy (or other foods) elimination can be difficult to
accomplish. Go thru the routine measures for handling oversupply and/or OMER
(the mom can have one and not the other, but often they go hand in hand)
such as : using one breast for an arbitrary period of time, like 4 hrs,
increasing this time span if needed. Be sure mother expresses any
overfullness esp. on the unused side, however she should express minimally
(for comfort) so as to leave some milk in the breast to signal a need to
decrease the supply. Have her watch for engorgement, plugs, mastitis etc.
Also monitor the baby's output and weight gain if needed.

Some other measures that can help: upright positions like straddling mom and
facing her, football hold, or if baby  only likes cradle type holds, then
make sure his shoulders are higher than his hips. The scissors hold can help
for mom to impede the OMER or any other way of 'pinching off' the stream.
Sometimes burping the baby more frequenlty and holding baby upright after
feeds for awhile can help.
I would advise the mom to try these measures for 2 wks and re-evaluate if
possible.

If it is decided for mom to try dairy elimination, to me it actually seems
easier or more do-able to have mom consume a low allergy diet and ADD foods
to this to identify what is bothering the baby. I can never remember what
this low allergy diet is called, but it consists of foods like rice, turkey,
lamb, and squash I think? It has been discussed and should be in our
archives.

How was the reflux diagnosed? Were swallowing studies done or ph studies
etc? Did the medication improve his symptoms? He may indeed have reflux
(GERD or gastroesophageal reflux disease I think) or other
swallowing/respiratory problems.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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