Diane--

I've had several of these babies in the last two months. One mom said to
me,  "If only he'd be happy for an hour!"  It is so hard on moms.  They
usually need lots of TLC and someone to let them know thay are doing a
good job.  "Wearing the baby" does help if mom is willing.

One of the things that I have found very helpful for these moms is to
use a three hour cycle at one breast and then go to the other breast.
In my experience as long as the baby is having 10-12 wets a day, there
is still a lot of gas and fussiness, even in the presence of yellow
stools.  I think some of that fussiness comes because the milk is moving
through baby's GI tract so rapidly.  Usually takes about a week to get
down to a lower volume of intake and to increase hindmilk production to
where baby is happier.  In the meantime they gain wonderfully!

By going to the three hour on one breast it seems to slow production of
foremilk a little sooner, because baby returns to the breast several
times during the initial days. I tell moms that if baby nurses well at
the designated breast and then sleeps or is content for the next 2 hours
without asking for the breast, that they are ready to begin alternating
breasts with each feeding or offering the second breast at a feed if
baby seems interested.

I also give clear instructions to only express the minimum needed for
comfort from the breast that is not being used during the three hour
period.  That bit came after having had one mom who kept pumping the
other breast because it was so full!  Talk about oversupply!  But she
was several weeks ahead on her freezer stock for returning to work.
Gave her a lot of confidence that she was going to be able to handle
work and baby!

A second thing to look at is what type of MER is present?  Baby who
fusses at the breast may be complaining that the milk comes too rapidly,
causing baby to gulp, or swallow very rapidly to handle the flow.
Gulping seems to increase gasiness, too.  And may mean that baby's tummy
is distended rapidly with rapid exiting of the milk into small bowel.
Overabundant supply and overactive MER do seem to be related in my
experience.  Thus moms tell you that baby didn't like the breast, and
their milk wasn't right for the baby.  It's so rewarding to see things
work out and know that they are off to a good start!

Melinda Hoskins, MS, RN