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Breastfeeding Issues
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ArreynGrey posted:
Having some issues (at 5 in the morning, of course) that I can't find answers to in the Q&A's: first, how long will it take my body to respond to my month-old son's feeding demands? He's been changing over to sleeping more at night and being awake during the day, and after more than a week my milk supply hasn't caught on-- still way too much at night (waking up engorged a few times every night) and not nearly enough during the day.

Also, how long does it take for breasts to "re-fill" after being drained? It's hard enough knowing my baby is hungry after he empties both breasts; it's even harder trying to soothe him while I wait for what feels like an eternity for my body to make more milk. It seems like my milk supply is suddenly (just this past week) completely inadequate for my boy, but he's gaining weight fine, so the pediatrician blew me off when I called about it. Well, it's lovely that he's gaining weight, but he's very clearly hungry pretty much all the time, and I'm not okay with that. If it was just a growth spurt, I would have thought that my milk would adjust or he'd calm down with his food demand by now.
Also, at first, my son took to breastfeeding like a duck to water. A few days after we brought him home, though, he started getting REALLY agitated all the time-- constantly fussy or crying, gassy extremely frequently, lots of red-faced arching and curling, lots of spit-up, and fighting me during feedings. It's been getting progressively worse-- he even fusses and arches in his sleep (so he doesn't seem to be resting, and is now perpetually tired... which makes two of us).

I mentioned this at his first doctor's appointment, along with the information that an extreme milk/whey sensitivity runs in my family. The doc totally blew me off ("Oh, lactose intolerance is extremely rare, and what you eat doesn't really affect him. He's gaining weight, so he's fine!") and I don't know where else to get help. I think I need to seriously modify my diet, but aside from cutting out the obvious dairy products (which does help but didn't fix the problem), I don't know where to start. I don't even know if this is actually the problem-- there are so many issues he could have, and the symptoms all seem similar.

So I have a constantly hungry, constantly tired baby. Neither he nor I (nor his dad, who can't stand to be in the house with all the crying) is very happy. Help??
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Sara DuMond, MD, FAAP responded:
ArreynGrey,
I am so, so sorry to hear that you are having such a rough time with your son. I am exhausted just reading your description...I know you've got to be fried! When there seem like there are so many possible things going on at once, and when it also seems like they might all be intertwined, I like to break it down into individual issues. First, the arching/spitting/pain/fussy symptoms that you are describing sound like textbook acid reflux. I am not his doctor, and therefore am not able to diagnose reflux in him, but from my estimation, it is absolutely worth scheduling an appointment SEPARATE from his well baby appointment to talk about this possibility. And soon. It's not dangerous, but the lack of sleep and general unrest that you've been having to endure is! Secondly, the hunger. This seems to have 2 probable roots - your body's lack of milk production during daylight hours and his inability to eat enough to stave off the hunger longer because he's likely in so much pain during feedings that he's cutting them short. The milk production issue should improve with time, but in the meantime, there are some herbal remedies that can help, under the direction of a lactation consultant. If your pediatrician's office does not have a lactation consultant on staff, contact the hospital where you delivered, as most hospitals have outpatient lactation services. You can schedule an appointment for you and your baby to be evaluated by the lactation consultant, and recommendations can be made from there to improve your daytime milk supply. The possible acid reflux issue, can be addressed, sometimes through medication, if that indeed is contributing to his ineffecient feedings. In theory, once that problem is fixed, he will be able to tolerate feedings better, therefore he'll eat more at each feeding, and therefore he'll stay full longer. Lastly, the issue of a possible underlying milk/whey allergy. Some babies with this type of allergy have obvious symptoms like blood in the stool, but other babies just have what appears to be very bad acid reflux symptoms. There is a way to test for this in your pediatrician's office. Even if the test is negative, breastfeeding mothers who still have a high suspicion can go on elimination diets to determine which foods are causing the problem...these dietary modifications can be spearheaded by your local lactation consultant as well, but most often include cutting out dairy, eggs, nuts, and wheat. That's a tall order for most moms, so don't try to take that on by yourself...contact a lactation consultant, please! Lastly, remember that if you're not thriving (because of lack of sleep and not eating and drinking enough), eventually it will catch up with your baby too...so don't put off getting help. You WILL get through this difficult time. Hang in there and keep us updated.
Dr. DuMond
 
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RS11518 responded:
My daughter (who is now 19 months) went through something similar when she was just a few weeks old. It seemed to be caused by my fast/strong let down (which I did not have with my son, who is now almost 4). My daughter would spit up a lot, couldn't get comfortable, had a lot of gas and and foamy stools from all of the gas. She would also sometimes choke while feeding because she couldn't keep up with it. She would fuss a lot until the gas passed, but by then she usually fed again! Is it possible that you are going through this? There are ways to fix it.

The problem with supply should fix itself in a few days as long as you just keep feeding when he's hungry. Just be aware that if you feed more often and you do have strong let down, then the problem with let down could get a little worse. If you want info on how to correct strong let down, look on the la leche league website www.llli.org.

Good luck!


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