Here is a story I hear through email quite frequently. We see several such cases in our clinic every week. “My baby is 5 months old and is exclusively breastfeeding. For the last 2 months or so he has been fussy at the breast, arching, pulling away from the breast, often not letting go while pulling at the breast which is causing my nipples to be sore. His bowel movements have been mucousy and green for the past month or so. He was diagnosed two months ago with reflux but being on medication for reflux has not changed anything. The doctor then thought that he is allergic to something in my milk because he started to have blood flecks in his bowel movements, but I had not changed anything in my diet so why should he suddenly become allergic to my milk? In any case, I have taken dairy products, gluten, soy products out of my diet for the past month with no improvement, though I thought there might be some improvement at first. In fact, things are actually getting worse. Please help.” Well, what is involved here? Why do babies act like this? The reason, in the vast majority of cases, is that the mother has had a reduction in the milk supply and the baby is reacting to a slowing of the flow from the breast. This is the problem of the mother who initially had an abundant milk supply and she may still have a very good milk supply, but the baby wants the fast flow. He may react in the very same way if he gets used to the fast flow of the bottle. In fact, the baby may continue to gain weight well, so it all becomes very confusing for the mother and the doctor and everyone else. But some babies do slow down their growth and some stop gaining altogether. This whole syndrome has nothing to do with reflux or allergy to breastmilk, cow milk allergy or late onset colic or the many other reasons that are brought out to explain this. Often the mother does not believe that she has had a reduction in milk supply because she can express lots, or that she sprays milk often, but I wish to emphasize that I’m not saying that the mother no longer has enough milk for her baby - what has changed is the flow of milk, the flow is slower than it was a couple of months ago. Babies react to milk flow, not to what’s in the breast. What mothers often say is that the baby drinks really well initially, for a few seconds or a minute, and he pulls away and the mother can see the milk spraying. So the flow must be fast, right? No, because what the mother sees and what looks like fast spraying milk is in reality slower than the sort of spraying the baby got when he was on the breast - only the mother didn´t get to see that. So seeing the spraying can be misleading. What can cause this to happen? There is a long list of reasons which are too long to go into here. One common one is that mothers who start off with an abundant milk supply are often advised to feed the baby on only one breast at a feeding or even do block feeding. But I have posted on this before and I don’t agree with “one breast at a feeding” or even block feeding to follow a rule. This is suggested sometimes routinely, but often because the baby coughs and chokes at the breast. If the baby cannot handle the flow, it’s not usually because the flow is too rapid, it’s usually because the baby’s latch could be better. We blame the breastfeeding, but the problem is the way the baby is latching on. These babies often get better on formula. But why? Because the baby now gets the milk flow that he desires and often more milk than they got before. And in the case of the babies who are truly getting less milk than they need, they are getting enough milk. So what happens with the majority of such mothers as wrote above? I try to make sure we eliminate any cause of a decreased milk flow and often we put the mother on domperidone starting with a dose of 30 mg (3 tablets) 3 times a day. And things improve, often quite rapidly. And the blood disappears too. Why? Here’s my theory: When the milk supply decreases, the baby starts reacting to the slower milk flow by pulling away from the breast and so as time goes by, spends less time on the breast drinking and gets mostly breastmilk which is higher is lactose and lower in fat and thus the milk rushes through the intestines quickly. In addition, the digestive enzymes from the stomach and duodenum get into the lower parts of the bowels where they do not usually get to and cause irritation. Subsequently, this may also change the bacterial flora and cause inflammation. The general clinical picture and the symptoms are then akin to irritable bowel syndrome in some way. The reason why increasing milk supply helps is that the baby begins to stay longer on the breast, gets more fat and the breastmilk takes longer to pass through the intestines. The same things happens when the baby is put on high calorie solids and is also a reason why low calories solids (for example feeding the baby just carrots which is what is frequently done here) doesn´t work.
Posted on: Thu, 20 Nov 2014 23:09:02 +0000
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