And the fact that the breastmilk digests the starch makes everyone go for
stopping breastfeeding, a pity, no?

Well, the first thing is to try other things besides express milk and put it
into a bottle.  Much to often "reflux" is diagnosed because of symptoms
which are really attributable to an "oversupply" of milk.  The answer is not
to take the milk and thicken it, the answer is to deal with the fact that we
give mothers poor advice.  10 minutes on each side?  Well, a sure way to end
up with "reflux".  Not that reflux does not exist, but gee whiz, can it be
as common as it seems to be all of a sudden, or is it the fact that the
formula companies have come up with a formula for reflux?  Even the tests
that are done for reflux are not infallible, far from it.

So what to do about reflux?  The first thing is to remember that "short
frequent feedings" reflects the bottle feeding mentality.  A baby who spits
up frequently and is bottle fed--short frequent feedings.  But when the baby
is breastfeeding "short frequent feedings" makes no sense.  A baby can drink
a ton in a very short period of time.  But babies rarely spit up while on
the breast.  So the trick is to let them fall of the breast, let go by
themselves.  Toward the end of the feeding, they are drinking very little,
but the stomach is emptying, so they spit up and reflux less.  Many babies
with reflux have been "cured" this way.

So it doesn't always work, I know.  Some babies manifest reflux by drinking
for a short period of time and then pulling at the breast and crying and
arching.  But many babies do this because they want faster flow, not because
they are having pain.  They are used to the very fast flow that comes with
the abundant supply the mothers often have, so when it slows, they tell the
mother they want it faster.  How do we get the milk to flow faster?  Better
latch (these babies are invariably poorly latched), and compression.  And
the same tricks we use for so called "foremilk hindmilk imbalance", another
term I dislike, incidentally.

And by the time we've worked all those through, the baby is better, even if
none of the tricks have worked.

It would be just soooooooooo nice if the first step were not taking the baby
off the breast, but now I'm dreaming.  (I know, it's not the first step
where you work, just ranting as well as dreaming).

Jack Newman, MD, FRCPC

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