Does this mother have other symptoms of Over Active Ejection Reflex? My first 
guess would be OER. 

The problem with pumping during OER is that it often perpetuates the 
condition. The goal is to "tame" the Ejection by only stimulating the breast 
enough to feed the baby what he is requesting. Over stimulation, by pump or 
hand expression often can simply cause the ejection to remain high, especially 
if Mother is pumping AFTER a feed, trying to "empty" the breast. 

I have written some articles about OER, although some of the info is old, it is 
mostly still relevant. 

One of the things we found years ago, which has been ignored in recent years 
is that women with low salt intake often have more problems with both OER 
and mastitis. This is mainly anecdotal, but I have seen more women with both 
situations improve rapidly by simply salting their food. We had an explosion of 
OER in the late 80s, when the low salt diet fads were popular. Too many 
people, even now, think table salt is "bad" for them, and it simply isn't (unless 
she has some kidney problems, or sodium sensitive hypertension, which I doubt 
is the problem here.) 

If this were my client, I would talk to her about nursing the baby on Cue, but 
making sure to follow regular OER protocol (nurse frequently, don't over stem 
the breasts, don't supplement, take baby off of breast during ejection, if baby 
is choking or having a hard time with either swallowing or green or too copious 
stools (my guess is an 8 month old would have figured this out by now :) ) 
etc. I can sent you a yet to be published fact sheet on OER and it's 
treatment, if you like. This baby is on solids (cereal, hmm, maybe talk to her 
about rethinking that, and using a food with better food value, like some fruit 
or veggies) make sure the baby has a FULL feeding at the breast before 
offering the solids, and if she doesn't' want the solids then, she simply doesn't 
need them. I have found, though having OER myself, that babies whose 
mamas have OER tend to do MUCH better with self feeding, little cubed pieces 
of cooked potato, cooked carrot, cooked apple, cooked pear, cooked squash 
peach, banana (watch for any constipation with this stuff) and allowing the 
baby to only eat what she can stuff into her mouth herself. This is an 
excellent plan to avoid over feeding of solids, especially if mom has OER, but 
for other babies, as well. 

You mentioned she had the first lump in the armpit. I wasn't sure if this was a 
continuing problem or not. If so, check her for a possible supernumerary breast 
or Tail of Spence. These both respond VERY well to cabbage compresses, just 
don't get the cabbage on the breast itself. (as baby is starting solids, I always 
worry about supply, even in a mom who may have OER.) 

Contact me if you like, my original articles are on the LLLL web page, and used 
to be on kellymom.com, but were, er, co-oped with someone else's byline of 
late.

I would be happy to send you the unpublished, updated hand out sheet. 

Good luck.

Mary Jozwiak IBCLC, RLC, LLLL
Private Practice 

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