Kirsten, I take a careful history of weights  (and if these are taken 
with clothing or naked in a fresh diaper), behavior, and of feeding 
methods, meaning formula and breast or just breast. I ask mom if she is 
pumping, and with what kind of pump and how much she gets out. Moms who 
can pump out several ounces after nursing with a manual pump, or 4-6 
ounces with a manual pump if skipping a nursing, are candidates for over 
supply. If baby is gaining weight well, we might try single sided 
nursing first.

If there are other problems, like sore nipples, or a fussy fussy baby, I 
want to do a consultation with test weights. These test weights are very 
indicative of what is going on. I weigh before nursing, and then at the 
first sign of fussiness at the breast or when baby first pulls off. I 
have seen babies slide down to the nipple tip or squirm their little 
bodies in contortions and the weights show great intake in a short 
amount of time. I have seen babies take in 4-5 ounces in about 5-10 
minutes and then come off crying and fussing. I can show mom that baby 
is not still hungry after a 4-5 ounces intake! I did have one mother on 
antibiotics and her baby had bright green stools until she finished her 
treatment. Most  of the time, it takes several days to a week to see 
results when going to one sided nursing at each session. Sometimes it is 
quick, but sometimes it takes a while.

The opposite is also true, I have seen when a mom is convinced baby has 
food allergies, colic, or she has too much milk, and the real problem is 
baby is not removing milk well and is starving! Rather than over eating. 
Once we increase baby's caloric intake, the problems cease, including 
green stools. (These babies have not gained weight appropriately and 
test weights show very little intake and not enough to grow on.)
Kathy Eng, BSW, IBCLC

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