Dear Janna,

How long have you been working with this mom?  You said she still has
lots of milk.  With really big over-producers, it takes some time,
several weeks at least,  for milk-reduction strategies to work.  You can
lengthen the time that she spends on one side - I have heard of some moms
going up to 12 hours or more on one side (empty the other to comfort by
hand expression/pump). She would need to keep a close eye on any signs of
engorgement, plugged ducts, mastitis, etc.

She might also want to try using sage to decrease her supply - the tea
can be made by infusing 1 TBSP of
dried herb in 1 cup of hot water - steep for 10-15 minutes; drink 1 cup,
3 - 6 times per day or she could use a tincture instead:  30-60 drops of
tincture, 3-6 times a day.  Some moms have found this to be very potent,
so be careful not to overdo it once she is seeing some results.

Is there also OAL (over-active letdown);  if so, let the beginning of the
feed spray into a diaper or towel and attach the baby after the initial
flow has subsided.  Alternately, she might want to hand-express or pump
for a few minutes before putting baby to breast to remove some of the
foremilk before beginning the feed.  Of course, this may not be helpful
in the overall scheme of trying to reduce total production.  Giving the
baby the lactaid drops before feeding may also help - a recent poster
found it to be very effective in one of her clients, although I have not
tried it myself with anyone yet.

A week or two of diet modification can't be any worse than dealing with
what she is right now.  I did find that my very cow's milk allergic son
had no problem with goat's milk or rice, and I used these a lot in my own
allergy battles.  She can get her calcium from other sources - most
easily from calcium/magnesium supplements.  She is not a big citrus juice
drinker, is she?  This can also lead to extreme fussiness for some
babies.  What kind of vitamins is she taking?  Do they contain a lot of
iron?  Also seen this to cause problems in some babies.

Until this baby starts feeling more comfortable, he will continue to be
very "high need".  I also had one that needed to be held all the time -
luckily he was my first.  He was very allergic with excema.  He still
can't sit still (20 yrs. old).  But we used a combination of front and
back carriers to keep him happy.  There really is no reason why she can't
attend to her other children with baby in a carrier or sling - mothers
have been doing just that for millions of years.  I found that once I
accepted that my child was the was he was, everthing got a lot easier,
emotionally speaking anyways.  But I'm guessing that if some of this
other stuff gets taken care of , the baby will begin to mellow out a
little.

I guess I would go with aggressive milk reduction strategies and dairy
elimination (milk, cottage cheese, cheese, yogurt) for the next 2-3 weeks
and see what happens.  Couldn't hurt to try the drops, too.  Once things
are under control, you can play with the variables and see what happens
(eliminating the drops, adding dairy, etc) but only do one thing at a
time and give it a week or so to see what happens before changing
something else.

Good luck.  I hope some of this helps.  If there is no improvement after
supply reduction and dairy elimination, you might want to look into more
extensive diet modification or possible reflux problems.

Warmly,
Sharon Knorr, BSMT, LLLL, IBCLC in Newark, New York (near Rochester)
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