Breastfeeding issues conflicting advice...

[Taranta]

I've posted about a couple of BF related issues recently, am continuing to have problems, and am getting conflicting advice from HV and GP.

DS is now 4 months old, still very unsettled/unhappy a lot of the time, cries a lot when waking up, sleeps for only short periods (nights from 8pm usually 4hour stint then 1-1.5hr long bursts of sleep interspersed with feeds till 5.30ish) only naps for 30 mins here and there daytime.

For the past month he's been increasingly difficult to settle and waking more frequently, farting a lot, and been pooing up to ten times a day, very runny and often greenish. Following some BF issues I have worked up from mostly FF to mostly BF (all but pre-bed time feed) but for the past month his weight gain has slowed considerably, to a few oz per fortnight. HV has instructed me to add in more formula feeds - she says the runny nappies and grumpiness and frequent feeds during night are caused by my milk being too low calorie, that I've tried hard, but now I need to accept i need to move back to supplementing. GP, who saw DS during one of his spectacular meltdowns, puts his crying down to him being a fussy/windy baby, and the runny nappies to teething. They are however checking his poo for lactose intolerance...
I don't know who, if either of them, have the right idea about what the problem might be.
I don't have a problem with formula, but I was so thrilled to be so nearly exclusively BF DS after the problems I'd had so this is a real fricking knock back if i go the HVs way. The fact that I was feeding him myself and he seems to love it made it worth the almost weekly blocked ducts in my mastitis-recovered right boob. I don't want to decrease if I don't need to, but I don't want DS to be going hungry and with an upset tum because I selfishly want to feed him all by myself.

What would you do?

I would avoid seeing again any HV that was talking about low calorie breast milk for a start!! Then call the national bf helpline and find a trained bf supporter near you. Continue with GP re milk intolerance. And did I say ignore your HV?!
fwiw I have a 4mth old dd. Night times are exactly as you describe, day time naps wildly vary, she farts a LOT! main difference less poos and I think she sounds a bit less unsettled. But I don't think your sleep times etc are anything to worry about?

Thanks Caz10, there was a great local bf counsellor I saw at a BF caff for a while who identified DSs tonguetie at week 5 and really helped with latch, but I suppose part of me feels a failure heading back there with all the new mums again at week 17. But i will. I'm just so bloody tired!

(To be clear the HV I assume meant too much fore milk when she said low calorie)

ok first i would say it isn't lactose intolerance.

breastmilk and formula are full of the stuff. he'd be very ill by now if that was it.

it COULD however be a cow's milk protein intolerance. virtually impossible to test for, mainly diagnosed on parental observation.
causes all the symptoms you describe.

so i would have a dairy-free trial. you need to cut it out of your diet so he doesn't have it via your milk, and you need a hypoallergenic formula for any formula feeds he has.

btw your HV is wrong about the milk.
the less milk you have in your breasts the higher the fat content. so if he feeds very frequently he should be getting more high-fat milk

When he feeds, does he feed for long?
What I think (hope) the HV was angling at was the fat content of the milk he is getting.
To get a 'full feed' he needs to start off with (what used to be known as) foremilk, then carry on feeding to access fattier milk (aka hindmilk). Sometimes if only the foremilk is drunk, the poos can be greenish. Does he pull off, or (quite likely around now) get easily distracted when feeding? Can you try to feed him in a quieter room so this doesn't happen?
(My DD is 5 months now and is reaching the point of telling DH to shush when he comes in or she'll pull off and stop, then get cross later as she's still hungry. Been through the same with both DSs too)

The sleep - well not a major concern, just read through the April PN thread and you'll see similar stories.
Teething? could well be, and worth remembering that teeth fidget about in there for ages before coming through, causing lots of excessive saliva which, when swallowed, can cause greenish poos & nappy rash.

Also - if he tests positive for cows milk protein intolerance, don't let them bully you into stopping bf - it's a source of disagreement but you can cut out dairy yourself and continue bf if you choose.

Very rarely would I agree that adding more FF would help solve a problem that adding more BF wouldn't, if that makes sense?
And well done you btw :)

Do go back to the bf cafe! I was a regular at ours for six months and bf till DD was 20mo! I had a different problem every week it seemed and the support was wonderful. I only stopped going because we moved - still needed them at times!

And yes do go back, the BF group I help to 'run' I've been going to for 5 years :)

You never know what problems may come up in the future, DD was 3 months when it started hurting again - we concluded some hormonal change in me as nothing else was going on. DS2 went on feeding strike at 8 months for a few days, the group kept me sane. etc.etc.

x-posted earlier btw.

thisisyesterday would cows milk protein intolerance cause an immediate problem from birth? There was a time when the nappies were fine - the symptoms have definitely worsened in the past month, which is why I assumed it couldn't be a reaction...

I would say the sleep patern sounds absolutely normal comparing to my two. I also think HV sounds rubbish. I think the ff could cause a problem, my ds was dairy intolerant and symptoms sound similar. I exclusively breastfed and cut out dairy from my diet and he improved dramatically, HV kept telling me weight gain not enough and kept hassling me to formula feed - total rubbish, i stopped seeing here. true it means that your baby will wake up more frequently to feed.

Have you got a good pram where baby can sleep in the day for longer while you are out and about? that might be good.

I gave mine bifida bacteriu, infantis (from health food shop) to settle green poo - you can take it yourself and he will get it through your milk, also i took eskimo kids fish oil to ensure got enough essential fatty acids without dairy and replaced milk with oatly oat milk - cheapest from asda - with added calcium - the red one
hth good luck

AFAIK the reaction can build up, a friend's DS was fine to start with, then suffered v badly with his reaction.

Just to add it can take up to 2 weeks for you to notice an improvement when you go dairy free so don't give up too soon if you choose this route.

Ignore your HV - breastmilk actually has more calories in it than formula! home.kellymom.net/nutrition/vitamins/babyfoodcalories.html

Has your son been checked (by a bf professional rather than a MW or HV) for a tongue tie? Symptoms of TT can be "colic", blocked ducts / mastitis and poor weight gain.

Certainly agree with going back to the group. That's what they're there for!! Look, I'm a peer supporter and trainee breastfeeding counsellor who runs bfing groups - but I go to LLL groups as a mum, not a supporter, and I still phone the helplines or see my local NCT counsellor and my son is 15 months! So they would certainly want you to go.

The sleep you describe isn't totally unusual (although it's at the far end of bearable...). I presume you co-sleep? My DS2's sleep was very similar and that was the only way I survived - although he did the 1 - 1/2 hr thing until about 8am which is much better than 5... But, something is clearly bothering him so I'm sure that it will improve when you get to the bottom of the problem.

There's nothing selfish about wanting to breastfeed. It's a gift you're giving to him and any breastmilk is wonderful. Your HV is talking absolute c**p about the calorie content although as has been mentioned, she may be mixing it up with foremilk/hindmilk stuff, but the issue here wouldn't be calorie content. Frequent night feeds are very good for milk production and rich milk so that's rubbish, too. It does sound like something's upsetting his tummy. Has he had a virus over the past few weeks? Sometimes that can trigger temporary LI but that can be treated with drugs until his tummy sorts itself out (and you can keep breastfeeding).

You might want to see what the results of the LI are and at the same time I'd definately go to the group - you never know what they might spot that it's not possible to tell from a post here.

Thanks all for advice, will definitely go back to the BF caff.

Bert2e I had mastitis at week 3-4, DS had a Tongue tie which was clipped at 5 weeks, then no more mastitis but i think I had a lot of nipple damage caused by a poor latch on the side that had had the mastitis which I think is why it's susceptible to blocked ducts all the time. Also have what I think is vasospasm issues in that nipple, really stub-your-toe painful on that side after feeding and white nipple til the blood comes in again. Clearly the latch is still a problem, through DS does really empty the breast and I get a lot of milk that side. I just thought the slow weight gain was because of all the poos, not my milk!

Kalo12 thanks for the tips. DS has never been a sleeper, I do use a pram to walk/nap him in but of course that mean no sleep for me!

JKSltd DS has always fed little and often - I fed on demand since birth - it's only at night he really concentrates on the job the past month though. I assumed he was getting his fill in, as during the day he's a fidget and always pulling off like you say, mostly to complain but sometimes to smile

Incidentally i took DS to a cranial osteopath today I've been so concerned as how unhappy he is and he bawled hysterically through the whole thing. I'll feel terrible for all the dairy I've been chowing if it is cows milk protein intolerance making him so upset...
Back to the GP for a test then...will try cutting dairy as of tomorrow and see what happens...

taranta... it can be from birth, it can build up gradually or it can appear from nowhere. it can be caused by things like a bout of gastroenteritis too.

i am reading your op again. you know breastfed babies do tend to plateau around the 4 month mark anyway... they will often gain quickly to start with and then even out, which worries a lot of people! so the weight isn't necessarily an issue
hmmm

Don't worry about him crying through the CO (I mean, other than it's awful to see them cry). It's not uncommon for that to happen if he's got a lot of tension to release. Have they suggested more sessions? Def well worth doing after a TT release.

Gosh, you poor thing, you've been through the wringer :(

Stop feeling guilty about stuff! What's the point of feeling guilty about the ice cream if a) it's not the problem and b) you didn't know anyway.

Going dairy-free means absolutely everything with dairy in (look for casein in ingredients). It's sneaky - so scrutinise packets. It should help within 2 weeks but of course the regular formula will have to go, too - but if you feel he needs it you can get a dairy-free one on prescription. Avoid all non-human milk - goat's and sheep too. I like rice milk or oat milk (best to get the one with added calcium). Booja Booja chocolate is to die for. Not found a decent ice-cream but ice lollies at least give the sugar kick!!

get the "vice cream" book organiccarrot...

if you have an ice cream maker it helps, but you can make it without too.

it's delish.

Organic carrot - DS Sleeps his cot in his room till the first wake, then I sleep there in day bed from first wake till morning. Alas He does like to feed lying down (screams) so its very much a process of feeding/rocking to slearms then stealth placing back in cot. If put down awake goes from mithering to hysterical in about a minute, but I'm not worrying about this right now, in a few months maybe.
Thanks for your words - was so deflated after seeing the HV...

Re the sleeping in pram- will he keep sleeping when it stops? If so just whiz once round the block, back home, park pram next to sofa and sleep sleep sleep! I used to love doing that with dd1, sadly now she requires my time if /when dd2 naps! We got it down to a fine art and didn't even need to leave the house!

Re night times, I would second co-sleeping if you can!

Also the bf group- I was still popping in when dd was (whispers) almost 3!

It's the damn centiles that the HV was plotting that started it - he'd dropped from 50 to 25 in a month.

Eeek - DS seems to be waking ahead of schedule for some reason...better go but will pick up on those points and get me to a BF clinic in particular)

sod the centiles and I've found the best way to find out just how much the HV actually knows is to demand ask for evidence. Odd how quickly they go away delegate care. Can only agree with PP about this.

Terrible night last night - usual frequency of wakings but DS just inconsolable after waking up on my lap about half an hour after a feed at 2am. He does this crying-before-he's-really-woken-up thing and went on for a good 30mins. No amount of rocking could soothe him. Sounded a bit more like groaning than out and out shrieking and what with all the writhing as well it has to be a tummy upset or terrible wind. Poor lamb .
Will tackle doctors surgery later, see if they've got results of poo test back yet...if as you guys supect it's not LI then will persist - a month plus of runny poos is just not right I know it...

To update, spent 4hours in A&E yesterday to see consultant paediatrician after referral from GP who didn't really know what to do for my screaming upset and dicky-tummied DS. They've narrowed it down to Reflux (which doesn't explain the weeks of diarrhoea) or as you guys suspected, cows milk protein intolerance (which does). Thanks for all your comments hopefully things are now moving in the right direction for the poor wee mite x

oh no 4hours in a&e sounds hellish! glad you got to talk it through with someone knowledgeable though and I really hope that you can get it sorted.

have they prescribed a hypoallergenic formula for his formula feeds? neocate or similar?

Hi TIY well they want to try the ranitidine first and then progress to hypoallergenic formula if the meds don't improve things. They are confused by the pooing frenzy and are doing more tests, tho, and they've given me an emergency follow up app for Monday afternoon when they'll decide for sure whether to go onto the Neocate too...
4 hours in A&E preferable to 20 week wait for a scheduled appointment (I kid you not!) tho downside is that they had me abstain for feeding till the paediatrician arrived and my already sore R boob got a bit engorged and this morning the dreaded red patch has appeared. FFS. Anyway at least I have a complete antibiotic prescrip for it from my many dealings with it before so I'll just have to wait it out feed a lot and see if the fever arrives... Sorry needed more punctuation in that last para!
Ps paediatrician also debunked HVs nonsense!

Hope things progress, 4hrs def preferable to 20 weeks! but no fun I'm sure.

Hang in there, the right kind of docs (hopefully) are on the case :)