Don't think baby is staying on first breast long enough but can't fix it

[YouMaySayImADreamer]

DS is 12 weeks old and ebf. I have always felt that he isn't staying on the breast long/actively drinking after I feel the initial let down and soon stops drinking and falls asleep. I asked about this but he was gaining weight well and latch was apparently fine so was told to trust my body and continue.

However when I got him weighed last week he had only gained 7 ounces in two weeks and dropped a centile. This wouldnt worry me on its own but it does along with the following symptoms:

His poos have always been frequent but completely watery and absorbed into his nappy fully. They have also been full of mucous often. He is also quite unsettled between feeds. He will initially either sleep briedly or seem quite happy but then start whinging soonish after and need feeding again. I have been waiting for this to settle but at 12 weeks it hasn't and there is still no obvious pattern or gaps between feeds, they seem frequent and snacky. He also sicks up quite a lot, and fusses and fights on and off the breast sometimes, sicking up but still not seeming satisfied. He also rarely has the milk drunk look.

I have been doing a bit of reading and it points to him not reaching the fatty milk effectively. It suggests he is getting a foremilk overload which means lactose overload which could be causing the fussiness, gas and bowel symptoms and could be causing slowed weight gain.

The problem is I cannot get him to stay on the first breast longer. He stops feeding and falls sleep every single time soon after the first let down. I have tried stripping him off, blowing on him, tickling, nappy changing, but he just falls back to sleep again. He also doesn't take the hint of breast compressions. What can I do?

you could try expressing before a feed? that way when he goes on he gets the fatty hind milk? or after and try to feed him some of the hind millk in a bottle?
does he ever choke on the breast? and if he pulls of does the slow stop or is it shooting out really quickly?

How long would I need to express for before? I have tried expressing after a feed in the past but nothing comes out.

He never chokes at the breast and only ever seen it spray once so don't think fast let down is a problem if that's what you're thinking?

yea thought that could be but as hes not choking its probably not.
try expressing for 5 minutes before hand
do u have any breastfeeding clinics around near u? I visited one with my 1st and they have excellent advice

No clinics but do have a local support organisation I could contact

Would you just pump off the first let down? Do you know if the first let down is generally the foremilk?

Ok. "Foremilk" and "hindmilk" aren't great terms. There aren't different compartments in the breast, there aren't two kinds of milk.

If a breast is v full of milk, hard and full, then the milk that comes out then will be a bit lower in fat, but still have lots of protein and nutrients.

As the breast softens, the fat percentage goes up.

So a baby will only end up low on fat if they only ever feed off full breasts.

Are your breasts generally v full and uncomfortable?

Babies are often unsettled, and their poos are often quite runny.

Could you speak to someone on one of the helplines? My understanding was that in general, if baby is feeding frequently, it doesn't matter if the feeds are short - they will still get the fattier milk.

Notquite I know there aren' t different compartments but my understanding was that the milk got fattier and creamier as the feed went on, and he needs to be getting to this stage. Also I thought that breasts got softer anyway once milk supply was established so I would only feel full if I was missing feeds and became engorged which I dont. Even on soft breasts therefore he would surely get only foremilk if he doesn't feed long enough?

I also understood that poos shouldn't fully absorb into the nappy as his do. There is no consistency whatsoever.

redkites what helplines is there please?

You could try taking off his socks and tickling his feet to wake him up to finish his feed

You can also try putting him back onto the same breast for the next feed rather than always alternating, especially if you express from the other one

Thanks closer ive tried tickling - really dont mean to sound defeatest but it doesnt work! He wakes and will even get peed off and cry but as soon as he is back latched on he drops off again!

I was wondering about putting him back on the same side but depending on how long itd been, wouldnt the next feed still start with foremilk?

Dreamer, all sounds absolutely fine.

The advice to express for five minutes before every feed is a tall order - time consuming, fiddly, and risks stimulating the milk supply too much, leading to engorgement, leaking and all round labour-intensive hassle :) :)

The poos sound on the normal spectrum.

His weight pattern is on the normal spectrum, including the drop of a centile.

Babies of 12 weeks may have got beyond the stage of 'milk drunk'. A lot - all :) - of what you say he does sounds normal, because all babies fuss and fight at the breast some of the time. Erratic feeding is something all babies do some of the time.

It may be that he is doing all of this more than other babies, but it still does not mean there is anything actually wrong -it's hard to say, and going to a bf group or speaking to a helpline is a good idea, so you can have a good conversation about it.

Trying to keep him on one breast for longer is pointless and difficult. By this age, babies know what they want and engineering the milk so he gets more of the fattier components is really not worth it....not for a healthy, thriving baby which is what he seems to be.

Going with the flow is probably the easiest option - all the rest of it is hard work, IMO :) Have someone watch a feed and they may come up with ideas on positioning and attachment, or else help you understand if it is normal and just one of the things your baby will grow out of.

Thanks tiktok I was hoping you might come along.

Is even the mucous in the poo normal?? Everything ive read says it is not a good sign for one reason or another. Also sorry I did forget to say that it always smells acidic/sour rather than sweet. He had a poo explosion last week and there were a couple of flecks of blood. I had been suspecting cows milk protein intolerence because of his symptoms but considering my worries about him not staying on long for feeds, after a bit of reading I wondered if a hind/foremilk imbalance was more likely as symptoms are the same. Is this a myth then?

I would absolutely love to go with the flow and not worry about this but my DS1 had a plateau in weight gain from 12 weeks after initial good weight gain, and dropped 3 centiles over the coming months despite appearing otherwise healthy and despite everyone assuring me before this that latch was perfect. So I fear history is repeating and that actually I am just rubbish at bf!

Dreamer, all babies have mucuousy poo at least occasionally - but do seek medical advice on this, in case this, along with the blood flecks and the acidic smell, are signs of anything you need be concerned about.

Fore/hindmilk 'imbalance' is just not a helpful concept anymore. It's true that the milk changes in composition as it empties, but this is not something that you need to 'engineer' in any way, except in extreme cases of over-supply (where you deliberately go hours between the use of each breast in an attempt to damp down the supply). In the vast majority of cases, babies left to themselves in terms of timing and frequency manage just fine, with no need for attempts to keep him longer on one side. I'd go so far as to say that many sources which talk about fore/hindmilk imbalance are basing their statements on old info, which has been refined and updated with newer evidence (not that new - I'm talking many years).

A couple if flecks 9f blood could be from a small fissure or chafe after an explosive poo - of course a GP can confirm this or rule it out. But it isn't always as serious as a food allergy.

Sorry not to have been back sooner. If you're still looking for them, there's a list of the UK breastfeeding helplines at the end of this page. They're staffed by volunteers so you may find it a little harder to get through than sometimes (although the first time I called one, it was a bank holiday weekend, and while it rang for a while, I did eventually get through to someone).

Thanks all - really interesting and useful information thanks tiktok. I have already taken him to the GP and explained that every single nappy is watery to the extent it is just a stain on his nappy, every nappy had mucous in, and every nappy smells acidic/sour. She didnt seem concerned, but I dont see how this isnt cause for concern.

Squizita there has been no blood since so touch wood this was a one off.

Redkites thats brilliant thank you.

I am going to keep an eye on his weight gain now as seems the only time anyone is concerned is if the weight gain drops off.

None if it soUnds too concerning, Dreamer. I know the smell you mean. And afaik it's nothing serious. Ditto the mucus. The doc has checked it all out. Time to relax? :)