Milk drying up at four months?

[stopgap]

As per title, I've been breastfeeding a week shy of four months. I've always had a plentiful supply and forceful letdown, but now I'm starting to think my supply is rapidly dwindling. Case in point, my DS fed from both breasts at 6pm, very fussy, seemed unsatisfied, and in the end I gave him 2 oz of expressed milk and he finally relaxed. This has been going on for a week, including last weekend where he nursed every two hours for 48 hours.

I'm going to start taking fenugreek and pump after every feeding. What else can I do? And when should I consider supplementing with formula, if necessary?

relax - its a growth spurt, coinciding with the four month sleep regression. see other threads on MN for example

you just need to keep feeding and not worry! your body knows what to do so trust it to make enough milk for your growing, developing baby.

feed and feed some more. Its a bit exhausting but this too shall pass

Phew. I truly hope so. I guess I've been blessed with an easy time of it so far, so to be presented with soft breasts and an angry, hungry infant is a bit of a (worrying) novelty. But I shall do as ye command--feed and feed some more.

your milk supply WILL catch up - and then when the growth spurt is over, you will be overflowing a little. If that is the case, pump the extra and store for emergencies

you're doing really well - hang in there!

So I went to a breastfeeding support group this am, and the lactation consultant calculated with her super-sensitive scales that DS got 3.6 oz from both breasts in twenty minutes. Previously it was more like 4.5 oz from one and a bit breasts, though in fairness it was a bit of a sleepy feed.

She said to feed both breasts in a sitting for a week, and if no joy, pump at 3 am for a week to stimulate supply (DS generally sleeps from 11am-7pm these days, so perhaps another reason why my supply has slowed). Or I could be getting my period.

My breasts just feel so soft compared to even a couple of weeks ago, and the amounts I can pump are vastly reduced. All normal at this stage?

I will say that DS is on Zantac for silent reflux, and while it's helped with his discomfort, he now spits up huge amounts, whereas previously it was only very small amounts.

sounds like the famous 4 months growth spurt.
just hang in there, make youself comfortable and eat loads of cake :o

It's normal - your breasts are getting more efficient at producing just what is needed, and no more. Hence the softer breast feeling. Baby wanting to feed more is putting in its order for the next day! The amount you can express is no indicator of how much baby is getting and I would be a bit at the weighing, tbh, it's not terribly helpful and seems like it's just making you more anxious.

Feeding both sides if your DS wants it seems like a good idea, or just pop him on the breast as often as you can (I also have a 4mo and I seem to be giving him a lot more short feeds in the day - every hour sometimes, but only for a few minutes).

just reading about your period: was the same with me, supply was a bit less during my period. has to do with conflicting hormones. but the empty feeling went away quickly.

Yes it's a normal stage - it means your milk supply has settled down. You probably won't get engorged again unless you go a long time between feeds. I am still feeding DS who is 3.2 and my breasts have been soft pretty much constantly for the last (almost) 3 years or so.

This article explains both the drop in pumping output and the softness thing, it has a link too which explains the softness in more detail.

Your lactation consultant did test weighing?

I'm very surprised, as I thought this was a fairly useless activity widely discredited by bf counsellors, and generally only good for stressing out mothers more.

I'm sure tiktok can provide better advice on the subject of test weighing though, but that practice would ring alarm bells for me, sorry. Is your lactation consultant a qualified bf counsellor, do you know?

Yes I agree the weighing seems odd, most breastfed babies will take varying amounts each feed and this is not a cause for alarm.

I wouldn't pump after every feed unless you need the expressed milk to feed him, you will just confuse the signals sent to your body. Feed him as much as he wants, offer 3, 4, 5 + sides if he wants them, and your supply will adjust to whatever he demands, it really will :)

stopgap, you can't be in the UK, I'm guessing.....no one has test weighed in the UK for decades.

VLC, US lactation consultants sometimes test weigh. I don't think there is ever any good evidence for this practice - and I can't see why the OP would need anything except maybe an observation of a feed and affirmation that her baby is normal, and to continue feeding responsively.

Babies of any age can go through periods where they feed more often. Taking fenugreek, pumping (at 3 am!!!?), and test weighing is sledge hammer and nut territory, in my opinion :)

But I am not there, I can't see the baby, and well....they just have different expectations and ways of working elsewhere.

Yep, I'm a Brit alien in NYC :D As with all things in this city, experts tend to be a little on the intense side.

My DS is four months next week, started at 7 lbs 8 oz and now weighs 14 lbs (he's just under 27 inches, though so a real string bean).

It seems to be the early evening feeds, Tiktok, when he seems frustrated by the lower milk levels. Since starting the Zantac, he has gone from feeding roughly every hour to ninety minutes, to every 2-3 hours, so perhaps my supply just isn't getting stimulated enough. I'm guessing a lot of his frequent feeding was due to seeking relief from the acidity.

Should I not bother with any pumping then, Tiktok?

Supply is not as fragile as we are led to believe :) Even if he has changed feeding patterns from little and often to more less often, your supply will adjust to this. Even if he has in fact dropped the amount he was taking, that wouldn't make your milk dry up. The fact he is still taking some will mean that there is always milk being produced.

Early evening fussiness is quite normal I think, they call it "the witching hour" - usually helpfully the time your partner arrives home from work as well, which is a bit of a shame for them, they miss all the happy gurgliness and are confronted with a screaming ball of baby who wants to feed all the time

Did you manage to have a read of the article? It's not very long but it has some good info.

Yes, I did read the article, BB--thank you for the link :)

stopgap - all I can say is that things would be very different in the UK. Your baby would be very unlikely to be prescribed Zantac (ranitidine) 'cos there is far less medicating of babies here (first choice for reflux, if diagnosed, here, would be Gaviscon which does not work systemically) and your baby would not have been test weighed and no one would be suggesting you pumped in the middle of the night...

Without more info it's hard to say what, if anything, you could be doing to improve things. On the info so far your baby could just be normal, your feeding could be normal, because fussiness in the evening is very normal at any stage, increased hunger is normal at any stage, and offering the baby more feeding, more breasts if he needs them, is usually the (simpler) way to go. No need to 'pathologise' things if you can avoid it :)

But if you are happy with your treatment and you feel it is helping, then remember your baby is being seen and a whole history has been taken and it's just not the same with a talkboard!

Disclaimer: have no expertise at all beyond bf my 2, and I bow in front of Tiktok's awesome knowledge.

I have learnt a couple of things since having my DDs, and that is

a) not to overthink stuff when it comes to bfing. Try not to watch the clock/monitor feeds. Just feed as much and for as long as they want and it's generally ok. (Wet/dirty nappies, general growth/demeanour and the fact that he sleeps 8 hours at night all say they are getting enough)

b) it all works out in the end, and my expending energy on reading/researching/worrying etc makes not a lot of difference to the outcome, so I'm better off eating cake and waiting for the passage of time to sort it out. (Try & remind myself this all the time)

You, your body & your baby are doing an amazing job!

PS - the engorged feeling went after about 10 weeks with DD1 and apart from milk coming in with DD2 I haven't really had it at all (not much gap between feeding the 2) and both have been EBF the while time - so fullness is not indicative of supply here. Also, I never managed to express large amounts but DD1 has followed 50th centile, and DD2 is following the 91st.

• the evening fussy stage is well-known. Usually happens when you're at your most tired and in need of a break/meal etc. This too shall pass.

What Fessa said.

The fussiness around that time of day is something that happens. My eldest is still like it and he is 3 and a half!

Just relax and trust your body, it knows what to do :)

Yes, tiktok, I imagine things are far more relaxed back home. As for the ranitidine, it has been a lifesaver. I'm the last person to go heavy with the drugs, but his reflux got to the point where he was having apnea episodes, wheezing, a cough etc. and constant wet burps and hiccups. Several times a day he'd choke on acid and scream for hours. Putting him flat: same thing. Just horrendous. We're seeing a pediatric GI on Monday, more for peace of mind than anything, and to confirm that it's actually GERD and not just colic.

Worth also looking into other reasons for these symptoms. Tongue tie and cow's milk intolerance (and other intolerances, via breastmilk) can sometimes cause reflux symtoms.

What I don't know is how ranitidine would affect these causes. Meaning, it works differently to Infant Gaviscon which has a mechanical cause, essentially thickening milk and making it harder to bring back - whatever the reason for it being brought back. If ranitidine works more specifically on the causes of GERD, and it's working, perhaps it's more likely to be GERD than the other potential causes. I don't know.

The point is only that reflux is dramatically over diagnosed in the UK (don't know about the US) and other underlying causes are often involved which if treated give better outcomes than giving drugs. I have no idea what your situation is but wanted to mention it :)

Thanks, OCC. We've checked for tongue tie, and I'm lactose intolerant, so avoid cow's milk like the plague (soy kills my stomach, too). The GI we're going to see is conservative about drugs, testing etc. So I'm hoping he'll be able to make other suggestions, and get our boy off the Zantac.

Do you know if Maalox is the same thing as Gaviscon? Gaviscon isn't really used in the US.

AFAIK, Maalox is another antacid.

Gaviscon only works on the milk, really , thickening it.