It’s a common complaint heard by physicians and lactation consultants alike: a mother calls concerned about her baby who rarely sleeps, is constantly fussy when awake and wants to eat all the time. A quick history with the mom also reveals gastric symptoms such as painful gassiness, explosive and at times green stools, and what is perceived as the baby's discomfort during feeding, which can interfere with the baby’s ability to nurse or take a bottle.
With these symptoms one would immediately be led to consider colic, which is often of unknown cause, or related to cow’s milk allergy. But, if this is a breastfed baby and cow’s milk allergy is ruled out, could there be another culprit?
Lactose overload or functional lactase insufficiency could be the other possibility. We have known about the symptoms for years, and even how to offer some relief for mom and baby, but research is rapidly expanding on the topic. It is considered a temporary problem that we often see begin around two to three weeks of age, and often improves by three months. The immaturity of the baby’s digestive system prevents the baby from producing enough of the enzyme lactase to breakdown the lactose received.
Lactose overload occurs more frequently in moms with large milk volume that rushes down through the ducts at times overwhelming the baby. Babies respond in different ways to accommodate the milk flow. Some babies will refuse to nurse and self detach and refuse to re-latch. Some begin to clamp down severely on the mom’s nipple to slow the flow, causing mom pain, and at times breakdown of the nipple which is an important part of the assessment. If the mom has had no pain previously this may be an indicator of a change in flow.
Arching the back during feeding and pushing away, spitting up frequently, having explosive watery stools—which can be yellow, green, or bloody—and experiencing rapid weight gain are all indicative of lactose overload. Breastfeeding rejection can be a late sign, and because of this, weight gain may stabilize or decrease if not identified quickly. Unfortunately, these babies are often labeled as having reflux, prior to making adjustments to their feedings and are even admitted to the hospital.
In breastfeeding education mothers are taught to feed their babies with hunger cues. With lactose overload, the baby is seemingly always showing hunger cues and acts as though they are never satisfied. Mothers follow the advice they are given in the hospital after delivery and put the baby back to the breast again and again. The vicious cycle begins with lactose overload as the milk passes too quickly through the small intestine before sufficient lactase can breakdown the lactose.
Treatment varies from mother to mother depending on the symptoms. If the mother's nipples have been traumatized as the baby clamps down to protect his airway from the rapid flow of milk, mom will often feel nipple pain when she may not have had it before. The good news is that once a weighted feeding has been done there are options of treatment.
Most moms have the greatest milk volume during morning feedings and this milk is typically lower in fat than the milk produced during feedings throughout the rest of the day. After a thorough assessment and history if mom is found to have an abundant supply of milk, and other criteria indicate lactose overload, she has several methods to decrease the over abundant supply. She may hand express the large rapid sprays prior to latching her baby on. This often will make the feeding more enjoyable and the baby more comfortable. If the baby still seems overwhelmed or chokes easily, stop and hand express a little more off prior to latch. If this does not stabilize after 3-5 days of this treatment, she may choose to offer only one breast per feeding.
As you slowly try this method, if there is no improvement you can try two feedings in a row on one breast. Hand expressing off each breast prior to use makes this the easier option when in public rather than using a breastpump. We often see a hyperstimulation of the breast when moms opt to use a breastpump instead of hand expression.
Afternoons and evenings milk fat tends to be higher while volume is lower. For some moms they will return to offering both breasts in the late afternoon and evening. When the mother perceives that her milk volume is lower, she can then use both breasts during later feedings.
If you are pumping and storing your milk, consider saving all of your pumped milk for 24 hours, and mix it all together prior to storing, in order to have a higher fat content in each storage container.
While treatment is very successful, it takes time commitment from mom, who must understand this is not a quick fix issue! She will need to remain in contact with her lactation consultant as the plan is adapted and altered based on the symptoms of her baby.
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In this brief video, Miranda and Kathy discuss the truth about what breastfeeding moms eat and how it impacts your breast milk. Have you removed several foods from your diet because you think your baby may be allergic? Did your mother tell you not to eat spicy food? You are what you eat? Join us today.
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Thank you for sharing this wonderful picture mama. It's always the right time and the right place to feed your baby.For those that pump and feed, a hand pump is great for those fall outings with the family. And breast milk is always the right temperature and can kept out of the fridge for 4-6 hours. Relax, enjoy and make sure to take a pumpkin home with you. #breastfeeding mom
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