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?

Glad you've seen a paed, and that you're getting what sounds like better advice now. Although for my money it's CMPI not reflux, with the poo you describe.

Apols if this has already been asked by a previous poster, but was your son's tongue tie treated? If not I would look into getting that done as soon as humanly possible - where there's poor weight gain, I think it's entirely justified, it's almost trauma-free in the majority of cases (they can use local anaesthetic). If it was treated, it's worth getting it double-checked by a lactation consultant to make sure it's not regrown. The hospital should be able to point you to one, and if not, then the Lactation Consultants of Great Britain website should sort it out.

If you're still BF, you need to exclude all dairy from your diet when it comes to the cow's milk protein trial (presuming the ranitidine trial doesn't bear fruit) as proteins can pass through breast milk. Whey powder is unfortunately hidden in many wierd and wonderful food products, so you need to read labels carefully. If NONE of this works, and cow's milk issues are ruled out, then there are other reflux drugs that can be tried.

PS if you feel so minded, do consider making a complaint about the HV - her advice was useless. If enough epople complain, maybe at some point the government will actually invest in some widespread re-training for HVs about breastfeeding.

Thanks Narmada, yes DS had his TT snipped at week 5 but that's good thinking about checking for regrowth will do that at the clinic next week. The left hand latch is perfect and painless but the right hand side has always been less good which I put down to nipple damage, I get a lot of blocked ducts that side and am batting off another bout of mastitis as we speak...

The paed did weigh DS yesterday and he's put on 2oz since last weigh-in ten days ago, not a lot but at least not less than he was. He's also a long boy on the 91st which I think makes him look skinnier on the 25th for weight.

My gut feeling is for the CMPI too - he doesn't seem to barf up enough for reflux and like you say it wouldn't cause all these nappies. Still DS did obligingly squit three tines for the paed so they've got plenty of material to check. Hopefully they can tell me something more at my app at the hospital on Monday. Dairy-free is going to be interesting but I bet theres a thread on here somewhere to assist...

I am thinking of raising it with the HV next app. I know that HV meant well but my experience thus far, of HV and some of th midwives to be honest, has been that they have so many to see they dont want or have the time to deal with complexities...

Hi - can't add any advice Taranta but just wanted to say how amazing you are! Seems like you're having a really relentless time and you continue to push on and look for solutions, rather than turning into a sobbing, self-pitying wreck dwelling on problems like I would. Your DS is very very lucky to have you.

Aw thanks . There is an awful lot of desperate muttering under breath of 'this too shall pass' of course...

It been a week or so now and I wanted to update/ask a BF question to you learned folk.

DS has now been on Ranitidine and Domperidone for 12 days for suspected Reflux, and will be reviewed end of the month by the paediatrician, if he is not improving then they will decide whether to go for hypoallergenic formula, and are testing his poo for LI/CMPI in the meantime.
Coinciding with starting the meds, DS has been refusing the bottle and so I have been exclusively BF him for 12 days. Three things have happened since then. First, teething episode aside he's been in much better spirits, and secondly, his nappies has decreased in number to 1-2 per days and are much more yellow and yoghurt- like in consistency. However, thirdly he was weighed today and has lost 4oz. HV supports me continuing to BF after LC (see below) wrote a supportive note in my red book. But should I expect him to lose weight like this when going straight to EBF or do you think it is still an intolerance issue...?

Incidentally, for those that suggested I returned to the breastfeeding clinic for help with a poor latch, thanks guys! I went back and the lovely LC had said that latch is good but am exhibiting symptoms of Reynauds. - I now have a letter from LC for my GP advising I be prescribed Nifedipine to help so hopefully thing o I'll improve there too...

Taranta, the weight loss you describe, after all you have experienced, sounds concerning. It may be worth discussing with your
LC whether you might benefit from a course of Domperidone...to be clear, I am not diagnosing anything, but sometimes after a prolonged period of feeding issues, supply can be compromised.

Can you check the weight loss?

It would not be the first time scales have been wrong, read incorrectly, translated from metric to imperial incorrectly....

Sorry just back on radar after time off line...thank you for posting.

tiktok - the weigh-in before this one was done on scales at the hospital straight after a feed - DS (then 18 weeks) was 14'10 which was up from 14'6 he'd been at the HV ten days earlier. The weigh in this week at the HV again another ten days later was back to 14'6 (i read it myself off the digital display) which the HV did say could be just down to a diff set of scales...
I have electronic scales at home but getting correct weigh in for wriggly baby v difficult even weighing him with me, then me on my own to work out his. I fear I may end up winding myself up with worry over another set of scale results. HV has asked me to go back in 2 weeks for weighing - she says he is alert and interested and not to worry.

But I am v worried - the only time I have EBF DS before was around week 3 and he dropped below his birth weight in a matter of a week having previously been well above on mostly formula, so I then i reintroduced formula on advice of HV and MW at the time. But we don't have the same mastitis and TT problems we had then so I thought it may be possible to EBF this time...

My LC believes I should carry on EBF and my supply will increase with DSs increased feeding so long as any BF issues have been resolved. I want to carry on EBF DS, and continue to do so, but I am not due to see the paed again until end of this month and that seems like a long time away if DS is continuing to lose weight like this.

lizzytee - I have been on Domperidone before early days to improve my supply after DSs TT was clipped - don't think it made a huge difference but I will talk to LC about it. I am just trying to feed feed feed.

Meant to say also still waiting for results of DSs poo tests for intolerances...aaargghhh there's so many things it could be!

My understanding is that testing poo for cows milk protein intolerance is not the usual way of doing it - and testing it for lactose intolerance, while possible, gives unrealiable results in infants.

You might want to check this. Are they sure this is the right procedure?

It's so unusual for an apparently healthy thriving baby to lose 4 oz weight in a week (normally, weight loss would be explained by recent illness) that my money is on the scales weighing inaccurately.

Is it possible to test for intolerances via poo? I didn't know they could do that!

I am not a doctor, but I have never heard of testing for CMPI via poo....in lactose intolerance it is sometimes done in adults and older children. Testing babies often gets a positive result (I am told by people who know about these things) but this just reflects the immaturity of the gut, not an underlying condition. Babies who have congenital LI are very, very rare and do not thrive - symptoms appear from birth. Secondary LI can occur after a tummy upset, but there are other symptoms.

tiktok I've checked the clinic letter it says awaiting results of 'reducing substances' and will 'look at milk allergy manifesting as reflux' at the next app.
If, as you say, LI is often picked up in babies then I guess what's troubling DS could remain obscure for a while yet. In the meantime I can only keep trying to feed feed feed and hope he starts to gain...

I was told there was no accurate test for milk intolerance in babies. Sometimes a RAST blood test will show positive if there is a severe allergy (think anaphylaxis) but in the majority of cases will be negative, even where a milk challenge indicates allergy/ intolerance.

I have never ever heard of testing stool for milk protein intolerance.... but I wonder if what they're looking for is occult blood in the stool - this can sometimes be present with CMPI?

Or they could be looking for signs of colitis/ bowel inflammation, which could also be caused by CMPI...but I am only guessing.

Third update from me on this and yes, I'm still looking for answers...

DS is now 23 weeks and has not put on any weight at all and has dropped a second centile to the 9th. He is maintaining his length on the 91st though and looks long and skinny. He has been on a bottle strike so am EBF him. He has been on ranitidine and domperidone for about a month but for the last two weeks the symptoms have been coming back - more green nappies, more curdled vomit, tummy discomfort, moaning during feeding and terrible sleeping, waking up crying. Also seems to have v itchy eyes but that could just be he's so tired as he doesn't sleep or nap well either.

I have been BF every 2-3 hours day and night, and have cut out dairy as best I can from my diet for a few days now. We are seeing the paed next Monday, and still await 'reducing substances' test results. I worry I'm not producing enough milk, though he always seems sated post-feed, and produces lots of wet nappies, but I have had a bout of mastitis again which has prob knocked things. Still so many variables as to what the problem is, I really need to get some answers soon for the little fella!

Just wanted to put it out there really in case you have any more thoughts...??

Hey there Taranta, what happened about you avoiding dairy? Could the symptoms returning 2 weeks ago be related to that?

Oh jeez, sounds like you are having a tough time

I have a bit of a bee in my bonnet at the moment about tongue tie. (ds1 is 6yo and suffering the consequences of untreated tt), and I am wondering if it was clipped properly?

have a read here

even if it was, sometimes they regrow, so definitely worth looking into again.

sorry you are having such a rough time Tarana :(

TaranTa, sorry!

I have been told green poo is due to the baby drinking mostly foremilk, before getting to the fattier milk in the breast. You might have an oversupply of milk like me, hence all your blocked ducts and mastitis problems. Your baby's stomach might get full with foremilk which does not fill much her stomach and she does not empty your breast fully. Usually milk is 1/3 foremilk and 2/3 hindmilk. If the baby gets only foremilk she is going to get hungry sooner and be unsettled. Being windy and have frequent poos is also a problem with oversupply. Try keeping her on the same breast for longer periods before offering the other so she can reach hindmilk.

Susemyoli, you say "Usually milk is 1/3 foremilk and 2/3 hindmilk. "

It is not possible to quantify milk in this way. Where have you read this???

" Being windy and have frequent poos is also a problem with oversupply."

Where is there any evidence OP has oversupply? Read the history, outlined in the first post - nothing there, as far as I can see.

Taranta, sounds hard for you at the moment :(

I hate to bang on about CMPI issues but I believe the advice is to completely cut all traces of dairy out of your diet for a trial period, if a significant intolerance is suspected. Things to look out for include whey powder, caesin etc. It's not easy as milk stuff is in everything, and you can't replace cow's milk with any other mammalian milks like goats' or sheeps' milk :( Soy can also be a problem for children with CMPI (but not always). If you're going to go dairy-free for a long time, I would seek a dietician's advice tho.

Hello again narmada v happy to listen to your words of advice re CMPI and have been rigidly no dairy since Sun. To be honest I lack the mental acuity to think food choices for a non-dairy diet right now, so for now it's meant not eating much of anything beyond salad, fish, decaf black coffee and fruit. It's certainly not all beer & skittles as a culinary odyssey but I have lost half a stone so hey it's not all bad news . I will talk to paed about my dairy-free-ness on Monday too...

Haven't noticed much difference expect maybe DS has had some quite unexpected daytime naps (he had his first ever 2 hour lunchtime nap yesterday - I literally didn't know what to do with the time and ended up wasting it spectacularly by watching Dickinsons Real Deal, the shame). DS has also been v chipper, doing a lot of standing practice wobbling like a little drunkard . He really is a little poppet, I just wish he could not look so fragile, sleep better, and be a bit more comfortable in his tummy. Incidentally we were trying him on a tiny smidge of fruit puree this week too, but it occurs to me that maybe fruit with his dicky tum is not the best thing...

Boobmeister have only just stopped the dairy so the resumption of symptoms a couple of weeks ago is not related to that. I thought it more likely the reflux meds were not working or too low levels.

TT is not regrown mawbroon - I had it checked by LC a couple of weeks ago. Sorry to hear that your DS1 is struggling with related issues now. I know such a lot of people now who had late diagnoses of TT for their babies that I am quite amazed given how common it is. It really impacted negatively on my BF confidence/experience for the first six weeks of DSs life...