Expert: Sally Wendkos Olds - 1/28/2008

Question
I was placed on some medication for 12 days and was unable to give 12 week old son breast milk so he was only on formula.  Now I am able to breastfeed and my son seems to be having difficulty digesting the breast milk.  He is spitting up a lot and long after he has eaten.  Should I slowly reintroduce the breast milk?  Do you have any suggestions?

Answer
Dear Melinda,

First, congratulations for giving your son the best start in life by breastfeeding him!

Spitting up is not usually a sign that a baby is not digesting his milk. The only time you need to consider spitting up a problem is if your baby vomits forcefully, so that the milk spurts vigorously out of his mouth for some distance. If your son is doing this, you should call your pediatrician since this may indicate a problem.

Otherwise, spitters are often the best eaters! (Personal disclosure: I had a spitter myself.) I am attaching an excerpt from my book (see below) which deals with this. I see no reason for slowly introducing breast milk -- if you have an adequate amount at this time, go for it! It may take a little while to build up your supply, though, after having stopped nursing. I am also attaching an excerpt about relactation.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters. Now in revision for a fourth edition, with Laura M. Marks, M.D.
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  The Spitter. Fat and healthy, she spits up milk after practically every feeding. She may continue this until she's almost a year old and you're convinced that you, the baby, and the apartment will always smell like cheese. (The smell is a lot milder while she's on breast milk alone.) If the spit-up milk shoots out forcibly in what is known as "projectile vomiting," call your baby's doctor. Otherwise, don't worry. As one experienced family practitioner has said, "In a healthy baby, spitting up is a laundry problem, not a medical problem." For suggestions on how to cut down on spitting up, see Box 10-7.
  
  BOX 10-7
  CUTTING DOWN ON SPITTING UP
  * If your baby seems to be gulping down milk at a fast and furious rate, try feeding him more often instead of waiting until he's desperately hungry.
  * If you're engorged, your baby may be swallowing air as she latches on. To relieve engorgement before a feeding, express a little milk and apply a warm or cold compress to your breasts. Of course, if you're feeding your baby often enough, your breasts will not get the chance to become engorged.
  * If your milk is coming too quickly at the beginning, express a little or let some flow into an absorbent cloth before nursing.
  * If your baby seems to be eating more than he can handle, nurse on one breast only at each feeding.
  * Prop your baby back at a 30-degree angle for 20 to 30 minutes after a nursing before you burp her. This helps the milk settle in her stomach and discourages it from coming up with the air bubble.
  * When you do burp your baby, do it gently.
  * Keep an ample supply of bibs and burping cloths at home and in your diaper bag, and stick to washable clothing yourself for the spit-up duration.
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  RELACTATION AND NURSING AN ADOPTED BABY
Sometimes a woman decides, or is advised, not to breastfeed her newborn infant; or she begins to nurse and then stops for one reason or another. Then, as soon as one week or as late as several months later, she wants to nurse -- either because her baby has grown stronger and is now able to nurse, because he has a digestive or allergic problem that makes it difficult for him to take formula, or for some other reason. In such a case, it is often possible to initiate breastfeeding. This process is known as relactation.
  In other cases, women who have adopted babies have been able to lactate, even if they have never been pregnant or have not been pregnant for years. This process is called induced lactation.
  Neither of these endeavors is easy; both call for a great deal of time, effort, and dedication. Both also require very close observation of the baby to be sure he is gaining weight properly. Many women who have made the effort, however, have been happy with their decision, especially if they look at it not for its value as a feeding method, but for how it can enhance the mother-baby relationship. This is the most important aspect of this kind of nursing. If you hold up quantifiable measures like the amount of milk you produce, the ability to provide all of your baby's milk, or the length of time you nurse your baby, you may be disappointed and frustrated. Based on several studies of women who have done this, the guidelines given in Box 16-2 should help you and your baby to achieve a happy nursing relationship.
  
BOX 16-2 SUCCEEDING AT INDUCED LACTATION OR RELACTATION
  * Ask yourself why you want to do this. If you'll be happy with the experience of nurturing your baby at your breast, and not necessarily nourishing him from your breast, you're likely to have a more positive experience than if you have your heart set on providing a set amount of milk. It's very rare for all of a baby's nutritional needs to be met with induced lactation and may even be difficult with relactation.
  * Be prepared for a stressful first few weeks, during which time your baby may resist suckling at the breast, your milk may be slow in coming in, and you'll be nursing almost constantly around the clock and supplementing your baby's diet with formula.
  * Find a support system, consisting of people who will encourage and help you through the difficult days. These people can include your husband, doctor, lactation consultant, La Leche League leader, and, most important, another woman who has done what you want to do, either relactated or nursed an adopted baby.
  * You'll find it easiest to relactate if your baby is under three months old.
  * Expect initial resistance from your baby, who is used to getting milk some other way. It may take ten days or longer for him to nurse well, but after that he is very likely to become an avid nurser. Don't give up too soon.
  * Nipple stimulation is the most important mechanism for bringing in your milk. The best kind of stimulation is your baby's suckling. Other techniques include breast massage, nipple rolling, and hand expression or breast pumps. (Expressed milk can be fed through a nursing supplementer.)
  * Nurse your baby frequently, whenever she shows any signs of hunger, such as increased alertness or activity, smacking her lips, making sucking motions, or moving her head around in search of the breast. Do not wait until your baby begins to cry, which is a late sign of hunger. In one study, most of the relactating babies nursed eight times a day, at intervals of two to three hours, with two night feedings. (This is an average; some babies need to nurse more often than this at the beginning.) The average duration of each feeding was about 20 to 25 minutes.
  * The most popular form of supplementing the baby's diet is the use of a nursing supplementer (see Chapter 15 and the Resource Appendix). This ensures your baby of adequate nutrition while providing stimulation to your nipples. Many women who considered their experience highly successful continued to use a supplementer throughout the course of breastfeeding.
  * It is extremely important to have your doctor follow your baby carefully for adequate weight gain. The suggestions given in Box 6-4 in Chapter 6 will help you and the doctor assess whether your baby is being well enough nourished for healthy development.

TECHNIQUES THAT ARE HELPFUL INCLUDE:
* Increasing your fluid intake and the amount of protein in your diet;
* Resting as much as possible, and lying down to nurse when you can;
* Asking your doctor to prescribe some other drug, like chlorpromazine or theophylline for the first week or so;
* Stroking your baby while she's nursing to help you relax and let down your milk.
* Providing as much skin contact as possible between you and your baby. (See the description of "kangaroo care" earlier in this chapter.)
* Also see the suggestions given in Chapter 15 for encouraging a baby who's gone "on strike" to nurse.

TECHNIQUES THAT ARE NOT HELPFUL INCLUDE:
* Keeping the baby hungry to try to encourage him to nurse;
* Using nipple shields;