Phone call from a lovely mother nursing a 24-month-old (feeding fairly 
frequently -- short feeds) and a one-month old.  The one-month-old is 
gaining very fast -- two pounds above discharge weight by the two week 
appt., and the mother  suspects  the one-month check-up next week will 
show even more rapid weight gain. The younger baby has become 
increasingly fussy, sputtering sometimes during feedings, with very 
forceful spitting up after most feeds.  Bowel movements are normal and 
yellow.  When the mother was away from the toddler during the day 
yesterday, and just feeding the baby, she got quite engorged.

I encouraged her to discuss the projectile spitting-up with the 
pediatrician,  and discussed that food sensitivities are sometimes 
linked with excessive spitting up. We talked about some positioning to 
help with the fast flow.  But this sounds like classic oversupply (which 
can happen even without tandem nursing).   And I'd love to hear some 
ideas on ramping down the supply with two very different nurslings.  A 
lot of the tandem breastfeeding literature stresses giving the 
vulnerable younger baby first dibs -- and this is quite the opposite 
problem!

 Perhaps she should breastfeed the toddler first when possible, so the  
younger baby is generally coming to a fairly soft breast.  But then this 
fast-gaining baby might then be getting a disproportionate amount of 
hindmilk.  (Though in most oversupply cases, babies are gaining very 
fast on too much foremilk, so maybe lower volumes of hind-milk would be 
better.)

Since either breast would be sufficient for either child, I suggested 
that assigning a breast to each would be the most logical way, at least 
for the next few months, to let each child balance out the production 
for their different, and changing needs. 

I also discussed with her the various herbal and medicinal routes for 
racheting down the supply, but it seemed better to work first with the 
body's own feedback mechanisms.

Any thoughts or experiences? 

Margaret Sabo Wills, LLLL, IBCLC
Maryland, USA

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