Hi Allyson,

It sounds to me, from the info you provided, that you are right in that the
mom has an abundant milk supply and that the baby is used to the fast
let-down.  The baby seems to be gaining well, mom is pumping large amounts
in a short time, the baby is spitting up, etc. all indicate lots of milk.

I have had success suggesting that moms in this situation breastfeed on the
first side until the baby comes off (5 minutes), burp the baby, and switch
to the other breast.  If the baby craves the strong letdown, the switch
will give him another letdown.  Often the baby is content to nurse longer
on the second side because he is a little more full and ready to nurse more
slowly and/or for comfort.  If necessary, she can switch back to the first
side when/if the baby signals he wants more and complete the feeding with
the "third" side, but the baby may have gotten plenty of milk without
this.

Sometimes babies fuss because they want more sucking time, but are
frustrated because the milk keeps coming at them when they are full and
don't want to drink anymore.  Nursing longer on the emptier breast (second
side) may satisfy this baby's sucking needs without the abundance of milk
to drink.

Try this for a while and see if it helps.  I don't think the mom needs to
increase her milk supply with herbs.  I think the signs indicate that she
has plenty of milk.

Barb Berges BS, RN, IBCLC
near Cleveland, Ohio

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Date:    Sun, 12 Oct 2014 20:52:10 -0400
From:    Allyson Michaels <[log in to unmask]>
Subject: fussy baby

Permission to post: Mother (g1p1) in to to visit because infant has been
increasingly fussy over the week. Mother felt that breastfeeding had not
started off well and that infant did not have a good latch. Infant now 6
weeks old. 3 weeks ago they had both been treated for thrush. It was this
last week after treatment stopped that infant had been fussy. She also has
seen infant spit up more. She has pumped occasionally. Once in the evening
she obtained 3 oz. Once in the morning after  a feeding, she pumped for
only 5 minutes and obtained a total of 3 oz. She stopped after 5 minutes
because the spray stopped....

Infant's birth weight was 8#7oz and at 3 weeks was 9# 13oz. The visit with
me @ 6 weeks was 11#1oz, which I calculated was slightly smaller than 1 oz
a day and certainly slower than the 1st 3 weeks....

At breast, infant fed calmly for 5 minutes before pulling off. Mother had
been noting infant doing this more and more, fussing after several minutes
but would return to breast for a couple of more minutes. She felt that
infant would have a squeaking sound with feeding. Infant would not return
to breast after the 5 -7 minutes but would just fuss at mother. I perceived
the squeaks to be swallows. Infant did not look to be in distress and
seemed to handle the feeding easily. However, infant did have a good crying
spell for over 10 minutes in my office before calming. She did return to
breast a couple of minutes each side more.

Mother has only used cross cradle so we tried straddle hold and I did not
hear many swallows. Once returned to cross cradle, at other breast, infant
had loud swallows again. Over the course of the feeding, infant took 3.2
oz. He did have some spit up but not large.

I am working on the theory that this child had gotten used to mother's
possible strong MER, hence the perceived poor latch and big weight gain in
the 1st 3 weeks. Now infant is fussy when MER is slower.  I wondered about
possible sore throat r/t thrush?

Mother asked about herbs, such as fenugreek but I am not sure that is the
way to go.

What jumps out at anyone else?

Allyson Michaels, RN, IBCLC
Charlottesville, VA

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