Expert: Sally Wendkos Olds - 6/23/2009

Question
QUESTION: Hello! My little boy is about to turn 8 months next week and lately
breastfeeding has been a challenge. It seems (except for in the morning
when I'm really full) that after 3 or 4 minutes or so, he doesn't want to eat
from the side he is nursing, but continues when I switch. It seems too early
for him to have drained the breast since I can still hand express milk but little
comes out when I pump, so maybe he is just a quick eater?? I suffer from
clogged ducts on my left side about 1 a week which has been really trying for
me so I just don't know if he is draining the breast as he should be. I would
also like for him to go to bed earlier (right now he's in bed by 9 after his last
feeding). He eats when he gets up (usually around 7:30), then again around
noon, 4:30 and 8:30. I've been feeding him solids after the noon feeding but
am going to give another session of solids after breakfast. Is it possible to
rearrange his schedule to allow for him eating and going to bed earlier or is it
best to stick with what we're doing? So sorry for all the questions...I really
appreciate your help!

ANSWER: Dear Kelly,

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

Your son's reluctance to continue nursing for a while is not uncommon at this age. Some babies become very playful at about this time and seem to become bored at the breast, indicating that they may be signaling a readiness to be weaned to the bottle. However, with a little patience you can often lure them back and continue nursing for some time.

Some babies do seem to drain a breast pretty fully in just a few minutes, but if you're developed clogged ducts, your baby is probably not doing this. If you continue to nurse, I suggest that right after a feeding you pump the breast that develops the clogged duct. You can save the pumped breast milk to give to your son in cereal or in a bottle or cup.

If you want to change his sleep schedule, try to give him an earlier evening meal of solids -- maybe at about 6:30 or 7. You would then move the other solid-food meals to earlier times also. Be prepared, though: if he goes to sleep an hour and a half earlier (say, 7:30), he may wake up in the morning earlier, so be sure you're okay with that before you try to change a schedule that seems to work for him!

I'm attaching an excerpt from my book (see below) about treating clogged ducts.

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 pediatrician Laura M. Marks, M.D.
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Clogged Duct (Plugged Duct, “Caked” Breasts)
In this condition, which can occur any time during nursing, one or more milk ducts are blocked so that the milk cannot pass through them. If you develop a clogged duct, you’re likely to find a small reddened lump on your breast that’s painful to touch. If not treated, this condition can lead to a breast infection, so take immediate measures, as suggested below.
• First, continue to nurse. If you stop suddenly, your breast is likely to get too full, the condition will worsen, and infection may result.
• Be sure your bra (or other clothing, like a T-shirt or sweater) is not so tight that it’s pressing on the milk ducts. Try a bra in the next larger size. Or try going without one, at least while you’re nursing. Also check other items that may be putting too much pressure on your breasts, like a baby carrier or a shoulder bag.
• Breastfeed more often and for a longer period of time, so that your baby can help you empty the breast, release the lump, and unclog the duct.
• Change your position with every feeding, so that the pressure of your baby’s suckling will hit different places on your breast, exerting pressure on different ducts.
• Express or pump milk from the affected breast after each feeding if your baby has not nursed long and vigorously, to get out as much milk as possible.
• If dried secretions seem to be covering your nipple openings, wash them off very gently after each nursing with a piece of cotton saturated with warm water.
• Offer your sore breast first, so that your baby will drain it more thoroughly.
• Apply moist heat several times a day (with a moist-heating pad, a hot water bottle, hot wet towel or washcloth, disposable diaper filled with hot water and squeezed out, or tub bath or shower). Be careful not to burn yourself!
* Gently massage the area of the clogged duct, especially after moist heat treatment.
* Try ultrasound at a physical therapy office or sports medicine clinic for one or two consecutive days. If the therapist is not familiar with this use of ultrasound, ask your lactation consultant to recommend the dosage.
• Rest as much as you can.
• Don’t wear a nipple shield, which will make it harder for your baby to drain your breast adequately.
• Don’t sleep on your stomach, which puts pressure on your breast.
• If your baby refuses to nurse on the breast with the clogged duct, see your obstetrician. There may be a changed taste in the milk from that breast, which may be a sign of an infection or other problem.
• If a lump remains for more than three days, see your obstetrician. While the lump is probably related to breastfeeding, it may not be and must be looked at promptly.
• If you repeatedly suffer from clogged ducts, consult a lactation specialist to reevaluate the way you’re holding your baby or the way your baby is suckling.






---------- FOLLOW-UP ----------

QUESTION: Thank you very much Sally for your input and clogged duct information. With
all the clogs I've had, I've become sort of an expert on getting rid of them but
your information is definitely helpful :)

Just a quick follow up question. When you say to have a solid meal at around
6:30 or 7:00, will this replace his usual 8:30 breastfeeding?  I'm not sure if I
could go all through the night starting at 4:30 pm or so. I've been thinking of
instead of only feeding him on a demand basis (which is usually every 4.5 to
5 hours or more), I would try feeding him every 4 or 4.5 hours regardless if
he's showing signs of hunger, with solid foods to follow. That may be too
much to ask from him though.

Thanks again for your help!
Kelly

Answer
Dear Kelly,

If you want to put him to bed at 7:30, you'll need to give him that last evening nursing earlier than 8:30. Maybe shift your schedule around so you nurse him just before the 6:30-7:00 solid-food meal, or vice versa. At his age he should be able to sleep through the night, and your breasts will adapt to the change.

What you need to do is try different things and see which schedule will work best for the two of you.

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 pediatrician Laura M. Marks, M.D.