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Subject:
From:
"Carol Schlef, RNC, MSW, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 28 Oct 1998 20:33:07 EST
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Hi all,

I tried to check the archives about this, but can't seem to get it to load a
search right now.  AOL????

Anyway, I got a call from a mom this week, asking what to do about making "too
much milk".  It seems she's still got large "knots" of milk between feeds
(they DO go down while bf), and what sounds like an overactive letdown reflex.

When I called her back, she explained that her baby has been diagnosed with
"severe" reflux, to the point that her ped (probably THE most supportive one
in St. Louis--bf TWINS during her residency for almost a year!) recommended
she get a "reflux sling" to attach to the bed so the baby would be almost
vertical when in the crib.  Up to now, baby has slept on mom's chest with mom
in a recliner, kangaroo-style (at ped's suggestion, I might add!).  During the
day, though, mom has been afraid to put the baby down at all, for fear he'd
spit up.

Here are the #s:

Baby is 5 wks old.  6#6oz. at birth.  9#12oz. in dr. office last Friday.
Today (in Reflux clinic) was 10#3oz.  Does this sound like a baby in
trouble???  Mom says he spits up at every feed, "a spot about the size of a
quarter or half dollar".  Does this sound like "severe" reflux????

Anyway, she was in tears on the phone just now, because the nurse in the
reflux clinic told her to NEVER put the baby in a baby carrier or sling
"because he could have MORE reflux and then he could DIE!"  Her exact words.
Now mom is terrified to leave her baby alone for even a second, afraid to use
a carrier, AND (as the nurse warned her!) afraid to let the baby keep sleeping
on her chest "because it will spoil him and create a vicious cycle and
overdependency".  AAARRRGGGHHH!!!

The nurse also suggested giving him rice cereal (at 5 weeks!!) to "settle his
stomach".  When mom asked ped, the ped was (I'm guessing) trying to be
diplomatic, and said "I wouldn't normally recommend cereal this early, but if
you decide to try it, don't use more than a tablespoon in 4 oz. of EBM, and
not more than one feeding per day." (She DID try one bottle with cereal, & he
threw up even more.  Duh.)

Mom had sobbed, "Everything I try, somebody tells me it's the worst thing I
could've done!"

Here's what I told her:  1) First of all, look at all you're doing RIGHT:
your baby is growing well on your milk, you've even got "extra" milk so you'll
be ready for the growth spurt that's coming, you've kept in close touch with
your ped and asked all the right questions, you've changed your sleep habits
to keep your baby comfortable and safe.  Next, realize that many health
professionals look at things as the "worst case scenario".  2) Also, most
babies that end up in a reflux clinic are formula-fed.  The "rules" are
different for formula babies--they are at MUCH greater risk of developing a
lung infection or SIDS, and getting very sick from reflux.  YOUR baby is NOT
at that much risk.  IF he does happen to inhale some regurgitated breastmilk,
it probably won't cause pneumonia.  (This baby has NEVER had an apneic or
cyanotic episode, BTW.) 3) You will NOT "spoil" your baby by having him sleep
with you.  Look at where puppies and kittens sleep.  Do THEY end up
"overdependent" from sleeping with their mom?  4)  You and your husband know
more about this baby and what works than any of us professionals.  You have
lots of ideas, now, on things that "might" work.  Try what "feels" right for
you.  If it doesn't agree with a particular nurse's opinion, so what?  If it
works, great.  If it doesn't, try something else.  5) Your baby will be
hitting a major growth spurt soon.  Hopefully, he'll "catch up" to your milk
supply then.  Also, his stomach will get bigger, and the sphincter should get
stronger, so the reflux should get better, not worse, the next week or so.

I don't like giving people more than 5 pieces of info at a sitting (actually 3
is usually the limit).  But I will be following up in a day or so. (Oh, I also
suggested ice after feeds to help with the "knots", and gentle pressure behind
the nipple while feeding to slow the letdown.)

Any suggestions on what else I can suggest for a) the reflux b) the "knots"
and c) the overactive letdown?

TIA!

Carol in St. Louis, where the leaves are turning, and it's as pretty as
Connecticut!

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