Expert: Sally Wendkos Olds - 6/24/2010

Question
QUESTION: My baby (almost 2 months) has recently been very fussy and I think it is gas.  I have started to help him when he gets fussy by bicycling his legs and it seems to help.  Then I started to investigate what could be causing so much discomfort.  I believe I have symptoms of Hyperlactation.  I´m just not sure if it is due to my baby´s schedule changing (sleeping through the night) or just me.  Shouldn´t my milk supply already be established?  Looking back my baby has always choked (not at every feeding but always meaning since birth), he has always come off and milk continues to spray (once again not every feeding), and he tends to be fussy while nursing (not every feeding).  I have read that hyperlactation doesn´t hurt him, but I hate watching him suffer with the gas.  From what I have read I understand that hyperlactation is normal until your milk supply is established and they always put one to two weeks after birth, but my baby is 2 months old.  
It is important to note that this last week and a half the symptoms have been way more noticeable.  He is choking more often and is much more fussy than he has ever been.  (crying curve?) And he has just these last couple of weeks started to go 5-7 hours without nursing at night.  Could this be why, and will it resolve itself soon?

I am an american citizen living in Chile (first time mom) and can´t seem to find any lactation help nearby...plus there is just some comfort hearing these things in your own language.  Thank you so much for your help!

ANSWER: Dear Michal,

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

I am attaching an excerpt from my book (see below), which may be helpful. If these suggestions don't resolve the problem in a couple of days and your son is still in distress, you may want to consult your doctor or a lactation consultant.

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. The fourth edition, with pediatrician Laura M. Marks, M.D., will be published August 2010.
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Excerpt:

If You Have “Too Much”  Milk

Abundance is wonderful, but too abundant milk production can cause two different kinds of problems.
   One can be seen when a woman’s let-down is so forceful that her milk flows too quickly into her baby’s mouth. The baby will gulp noisily, gasp, choke, gag, and sputter during the feeding. He may stop nursing after only a few minutes, only to burst into loud wails of hunger and frustration. A baby forced to drink too quickly in this kind of situation will swallow air, have uncomfortable air bubbles, hiccup, spit up, and be unable to satisfy sucking needs.
    The other problem can result when a mother has more of the high-lactose foremilk, the milk a baby gets when she first latches on, than is typical. A baby who drinks too much foremilk and does not get enough of the higher-calorie, more satisfying hind milk may become gassy and have frothy, loose, green bowel movements. To remedy this situation, try offering only one breast at a feeding and let your baby suckle at that breast until she seems satisfied. At every feeding, then, your baby will drain your breast enough to take in the hind milk.
   Oversupply can be corrected in one or more of the following ways:
• Express the first torrents of milk until it starts to come in a steady drip.
• Lie on your back or lean back in a recliner, with your baby lying on top of you. This allows the force of gravity to reduce the flow of milk from your breast and lets your baby control her intake more easily.
* Hold your baby upright, with his face slightly above your nipple. This may help him control how much milk he’s getting.
• If your baby starts to choke or spit up during a feeding, remove him from the breast, express a little milk, and after he has calmed down, bring him back to the breast.
• Be sure your baby is latched on and properly positioned. Some babies slide down a firm full breast and clamp down on the nipple, resulting in sore nipples for the mother.
• Offer just one breast at a feeding. If your other breast becomes uncomfortably full, express or pump just enough to relieve your soreness and save it for relief bottles. This will signal your body to make less milk. Over the next few days, your milk production should decrease to a level your baby can handle more easily.


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

QUESTION: Thank you so much for your advice, I just have some follow-up questions.

1.Would feeding on one side cause my milk supply to diminish to the point where I couldn´t meet my baby´s needs?
2. Could a birth control pill (mini-pill) be causing hyperlactation, and if so should I stop taking it, or would the above suggestions help if it were the situation?
3. My baby is just gassy, I have never seen green frothy poop in his diaper, he has normal breastfed poop...but could I still have more foremilk?-woman who produce more foremilk than normal do their babies grow normally and healthy?

I realize you probably cannot pin point my problem, especially over the net, but I don´t know where else to go.  Can his pediatrician be of some help?

Answer
Dear Michal,

1. If you do feed on one side, alternate breasts at each feeding. You might pump or express milk from the other side either while your baby is nursing or just afterward. This should keep up your milk supply.

2. The minipill sometimes decreases a woman's milk supply, so that should not be causing hyperlactation.

3. You may have more foremilk, but don't worry about it. Women who produce more foremilk than usual have babies who grow normally and are healthy.

And yes, you're right that it's hard to diagnose your problem without seeing you. If your pediatrician is knowledgeable about breastfeeding, she or he should be able to help you. You might also be able to find a La Leche League chapter near you.

• La Leche League International
957 N. Plum Grove Road, P.O. Box 4079
Schaumburg, IL 60173
Phone: 847-519-7730   Fax: 847-969-0460
800-525-3243 or US Helpline 877-4 La Leche
Email: llli@llli.org Website: www.llli.org

La Leche League International is the largest organization in the world devoted specifically to providing mother-to-mother support and education about breastfeeding. Local chapters, which hold monthly gatherings, are listed on the website. To find a chapter near you, go to http://www.llli.org/webindex.html or contact the league. You can submit questions through the online help form on the website. [http://www.llli.org/help_form] or take part in online forums [http://forums.llli.org].

Good luck! Sally
--------------------------------
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. The fourth edition, with pediatrician Laura M. Marks, M.D., will be published August 2010.