Expert: ruth kraft - 4/28/2009

Question
Hi Ruth,

My baby's 4 months 3 weeks and the whole breastfeeding journey had been
difficult. We started with supply problems, then at 2 months, he began to pull
off after every few minutes, and was very fussy. He wouldn't nurse long and
sometimes would choke and gag. When I consulted the lactation consultant, I
was told that I had an overactive letdown problem, as baby also refused the
bottle, she suggested we see an infant speech therapist.

I was not too convinced by her diagnosis as the pediatrician suggested that
it's more a reflux problem. I read about silent reflux and baby had many of
those symptoms. It was also strange to go from inadequate supply to
overactive letdown... I also did not have sprays of milk when I took baby off
after a letdown. Despite this, we pressed on - baby wold nurse slightly longer
while lying down and I got off the fenugreek and domperidone that I was
eating.

So now at 4 months plus, he doesn't really gag but he's super distracted and
pulls off at the slightest sound and movement. This makes nursing in public
almost impossible. I've also noticed that he refuses to nurse  in cradle hold
but it seems almost like its a matter of preference for the lying down position.

In terms of feeding duration, he goes 15 min on each side only when he's
sleepy. When he's awake, he sucks till one letdown then gulps the milk and
then pulls off distracted when the milkflow slows... and that takes at most 3
mins. I worry that he isn't getting enough to eat. He weighs 7.5 kgs at 4
months 3 weeks. As the feedings are pretty messed up, I need some advice
on:

a. How to get him to nurse for a longer time (instead of 5 min feeds) so I can
at least place him on some sort of schedule rather than feed him for 5 min
every hour?

b. His feeding pattern seems to follow suit at night when he wakes up after 3
am to feed and comfort suck.

c. Is this still a problem of overactive letdown? I'm not sure.

Hope to hear from you, thanks!  

Answer
I am sorry you had such an issue at first, it definatly sounds like there was an issue with overactive let down, common issue in the first couple months. and not likely an underactive milk problem, but that was more in the past so they shoulnbt be effecting what you are going through now. The potential reflux also sounds more like it, and it may have been a combination a little of both. as babies get older that valve for reflux gets more and more strong and spitting up happens less.

As far as the 4 month old pulling off.... Unfortunaly, they are social creatures and I have never met a mom who has been able to force her child to nurse when it has other things it would rather do. that includes feeding in 15 minutes vs 5.  he prabably gets most of what he needs in those 5 minutes. SO, if he is wanting to nurse every hour, and pulls off because hes trying to be social, you can do 2 things, one, if available go in the darkest least stimulating room possible, or two, if hes distracted by something else easily, then distract him. give him new toys, something he finds interesting, differnt play area etc. delay the nursing until he gets really hungry and wants to really focus on food.

cluster feeding in the evening is normal ( nursing every hour ) and so is waking once or twice in the night for comfort. esp after a good long rest like 4-5 hours then the early morning hours usually after 5 but it seems yours has chosen 3, they are up more often. I know its tiring, but it is what helps prevent sids in breastfed babies. there is a instincutal need to know they are safe and it would be better for him in many ways if you continued to nurse him once or twice at night if he needs it to feel secure.

Don't worry about him getting enough. Follow his lead and when hes hungry, he will eat. :)