I have been working with a mom from my nursing moms group who has a 17week
old baby. She called me Tuesday evening very upset that her pediatrician
recommended putting her baby on formula due to his extreme fussiness and
other behaviors. The mom was very upset and is not ready to wean or give
her baby ABM. The pediatrician suggested that the baby is suffering dairy
allergy and advised cutting out dairy for a "few days". The pediatrician
told her that if the behavior was not improved by Friday that they would
need to try the ABM. I advised the mom that it can take 2 weeks or more on
a dairy-free diet, including all "hidden dairy" to see results if the
fussiness was due to a sensitivity to cows milk proteins. Mom is willing to
do this and has been dairy free since Wednesday. She and I are both
thinking that her problems may be due to more than dairy (or maybe dairy is
not the culprit at all.) She has given me permission to consult with the
experts here and to share with you the emails she has sent me. The mom
writes:
>>>Thanks again for the info. I am going to try to eliminate all dairy from
my diet, but I came across some info about overactive letdown on one of the
links below. I think you would agree that I have an overactive letdown.?
I'm sure you are probably aware of the symptoms: baby is gaining weight
rapidly - often more than one ounce a day; normal development; frequent wet
diapers and frequent, explosive stools - often green; gulping, choking,
sputtering at the breast; arches, pulls off the breast and cries; frequent,
brief feeds; seems to feed more contentedly at night; never appears
satisfied; makes grunting noises during sleep; may spit up a lot. All of
these symptoms are right on the mark. I know you gave me a couple of things
to try, which I honestly only tried a couple of times. When I try to put
him into a different position (upright), he starts crying and will not latch
on until I put him back into the cradle hold. The option to express some
milk prior to feeding him is going to be difficult since I'm usually home
alone. If he's ready to eat & I try to put him in his bouncy while I
express, he is going to start crying which will just increase the gas in his
tummy. Similar scenario if I take him off the breast once my letdown begins
& I compress it with a towel. He is not a happy camper when I do this. I
am leaning toward OAL as being the culprit and will definitely keep trying
these methods, but do you have any other suggestions?
As a side note, I also read that breastmilk is made from what's in the
mother's bloodstream, not what's in her stomach, and most foods the mother
eats do not cause any problems in the baby. It did say the one exception to
this would be dairy, but that dairy sensitivities usually manifest in bloody
stools and skin problems rather than gas. He's never had bloody stools or
skin problems. What do you think?<<< (The mom did say that baby sometimes
has mucus in the stool but no blood and he does not suffer from eczema)
and the mom writes again:
>>>
It's me again. A couple more questions. I read that if you do have an OAL
it should correct itself as the baby gets older. That hasn't been the case
here. Do you know anything about that? I read about another method of
trying to reduce the forcefulness of the letdown. Use the same breast for
two feedings within a four hour period. Do you think that would mess up my
milk supply? (For instance, I would feed off the right breast for two
feedings in a row; then feed off the left for the next two feedings. He
usually wants to feed within 2-3 hours of his last feed, so I figured this
might work.) Your opinion is greatly appreciated. Thanks again!<<<
and today...
>>>Thank you so much. Please present my case to anyone who will listen. I
am at my wits' end. It is like we are starting all over from scratch. I
want to breastfeed sooooo badly, but if it doesn't get better soon I fear
that I am going to go to formula just to get some peace around this house.
It is getting pretty bad. Yesterday, I tried feeding him while lying back
on the couch, but he got frustrated. My breasts are very soft and his
little face just gets buried in them. It's like I would have to try to hold
his head up or something. Maybe I'm not doing it right. I'm going to the
store this morning. I'll pick up some cabbage leaves and try that. I will
try ANYTHING!!! Thanks again for all your help and let me know if your
group can come up with anything.<<< I had advised to mom to try applying
cabbage leaves to the breast for 5-10 min prior to nursing to see if that
helps with the MER.
Other things that might be helpful to know - The baby sleeps very poorly (no
more than 30-45min at a time during the day and wakes every 2 hours at night
from 8pm to about 530am when he is up for the day. He nurses about every 2
hours during the day and never seems satisfied (continually rooting, fussing
and sucking on his hands), even though weight gain is great (9lbs 4oz at
birth and 15lbs at 17weeks) and mom has abundant milk supply. The mom
reports that the baby grunts alot as well. He does exhibit many of the
signs of an overactive MER. It is also possible that she has an
over-supply, but I would think that would have resolved by 17weeks. Mom has
weighed the baby pre & post feed and has seen a 5oz increase on several
occasions. He has reflux as well and has been on Zantac since about 8
weeks. I am not convinced that this problem is due to dairy
allergy/sensitivity. What do you all think? I feel bad that I have been
telling the mom that the fussiness would improve as the baby got older, but
this is not resolving. Thanks for your input and suggestions.
Mellanie Sheppard IBCLC hopeful 2004
Arlington, TX USA
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