Overactive letdown, breast refusal and potential CMPA

[Fridasmama]

I’m not exactly sure why I am posting this, probably mainly just to vent but also maybe someone has something valuable to add.

My daughter is now 9 weeks old and I am
almost exclusively breastfeeding with the odd expressed bottle provided by partner.

My breastfeeding journey just seems to have been one issue after another and it’s really getting me down. Firstly, my baby has had explosive green poops multiple times a day since about week 3 or 4, alongside problematic gas, fussiness at the breast and also frequent vomiting/reflux. For these reasons they believe she may have a cows milk protein allergy and I have been on a dairy free diet since about week 4 to figure this out - however, I have not seen any improvement yet.

A few weeks ago, the fussiness at the breast increased and it became clear that my daughter was struggling with an overactive letdown, choking and spluttering and becoming very distressed. I have been working with Infant Feeding team who have recommended specific positions (These haven’t helped), pumping off the letdown prior to feeding (I have experimented with this but it doesn’t really seem to help so much as I have multiple letdowns during each feed and it also seems the general flow outside of the letdown is fast too as she struggles throughout. Also I am aware that overall pumping will just increase supply in the long term so I don’t love this approach) and block feeding (I have not seen any difference with this yet after even a few weeks).

I clearly have an oversupply as when I do pump I end up getting about 4 - 5 oz in 2 minutes on each breast.

Some of you upon reading this may point out it is probably unlikely she has a CMPA because frothy green poos are common with oversupply due to hindmilk/foremilk imbalance. I have suggested this to Infant Feeding co-ordinator who seemed to brush it off as ‘unlikely’ due to this being rare, which I found quite frustrating.

Some of the time, particularly when she is sleepy, she feeds well and takes it like a champ. This just makes things more frustrating when they inevitably deteriorate each day.

It has got to the point where my daughter often refuses to feed which I find unbelievably stressful, especially when she cries and appears inconsolable. I have found the attitude of health professionals I have approached to be generally uncaring, given she is putting on weight as she should be. It’s almost as if the attitude is that I should be grateful i have so much milk, with no consideration to the impact on my mental health. I was initially under the belief that this would settle down naturally in time but the Infant Feeding team just advised me this could be the case throughout my breastfeeding journey, which just made me feel so incredibly low.

I feel at a loss/at breaking point with it all. I have given so much to my breastfeeding journey and I don’t want to give up on it - added to the fact at present, due to the question around potential CMPA I am trapped in this cycle regardless, as I can’t give her normal formula but also don’t have a prescription for hypoallergenic formula either. But I feel like I just have no hope for figuring all of this out at all.

Has anyone been through anything similar?

I experienced something very similar with my first son, although he didn’t start refusing the boob until he was a few weeks older. Nothing really helped me either, he would only feed in side lying position at night time between 3 and 9/10 months.

Im sorry this is happening to you too, I also found it very very stressful. I’ve no real advice other than it might be a case of just waiting it out because they seem to find it easier as they get older.

In hindsight I think I should have just gone to combi feeding and worked harder at getting him to take a bottle for the day time. When I was pregnant with my second child I swore that if the same thing happened again I would just give up and bottle feed, and I’ve ensured that they will take both a bottle and formula (but luckily boobs are far less vicious this time round and baby is coping ok).

@keppoach thank you. To be honest I am looking at moving to formula, but until we straighten out this issue around potential CMPA it’s not really a possibility, which is kinda contributing to my stress as I feel very trapped. My partner really wants us to move over as well because he feels unable to help me at all and sees the impact on my mental health. I am currently combi feeding with expressed milk but this only seems to have served to drive my oversupply so I am trying to exclusively breastfeed as much as possible in the hope my supply will even out.

I did always plan to move to formula at 6 months anyway so it may be a case of just bringing that forward. Does feel a shame because when she is feeding well I do love it.

Hi there it's a midwife with infant feeding experience. Could you baby be overtired? I suggest you look into the thread Cluster feeding- at the end of my tether. You have a different issue however your baby does sound overtired at times from your description. Hunger and sleep are two separate issues each needing a separate solution. I hope it helps. If anything your daughter is very likely to grow out of it by 3-4 months. Hang in there, there's a light at the end of this tunnel

I had one side refusal with one child. I know you have a bigger issue than that, but perhaps there might be something you could adapt?

Feed to sleep in your lap if that is at all possible (you might need to express into a towel of something first to get the powerful let down done if they are refusing both sides), when asleep shift them to the other side (don't turn them round, just move along), and he would dream suckle on the new side. My only motivation with this was because I was so sore and uncomfortable, and it worked. He fed enough to make soreness go away, but also little enough that it helped reduce the volume I was making.

Alternatively express a bit in a warm shower to reduce any excess fullness and then feed.

I think I also adopted "laid back" position at home for a while and that helped with refusal. No use if you're out and about that one though!

I also donated expressed milk to a milk bank (fed one side, expressed the other) and had a lovely letter from the hospital re how grateful they were.

I’ve just remembered that feeding in a sling would sometimes help too!

Evem if you do end up getting prescription for formula, if you can keep one or two feeds at night then it’s not necessarily the end of your journey. My day time supply picked up again fine after 6 months of only feeding at night, and I kept going until a week after his second birthday in the end.

Yes yes yes

Fast letdown but had feeding assessments which showed actually she coped ok. If I didn't have a breast pad on you could hear milk coming out of my breast!
Reflux and allergies caused feeding aversions
It could be multiple allergies. My daughter has 20 and didn't reach symptom free until 15 months! Have you removed soya as well as dairy, half are allergic to both
She has also needed a heavy duty meds for silent reflux. I suspect she also has a mild tongue tie which wasn't picked up during the feeding assessments

If you want to go down the formula route and they are reacting to diary through breastmilk you will want either neocate or alfamino as these are completely dairy free

Hi, I know it’s been a while but I am in a desperate place and found your post, my boy is 9 weeks at the mo and I could have written this word for word… what did you end up doing, did it get any better?