Explosive, constant nappies in newborn DS - MW says he's getting too much foremilk - what to do?

[mrsgboring]

DS2 is now 13 days old, and pretty much since he's been born, he has a constantly stained nappy (as well as normal poos too) This has given him a nasty nappy rash, because literally every time you look in there there is a little dribble, and it's impossible to keep on top of the changes as it happens with no warning and very very frequently. When we can, he goes nappy free, and we're using Metanium, but it's not enough.

Apart from this, he's doing well. He's got jaundice which is taking its time to go, but weight is fine, and poos are the right colour.

The midwife said that the poo problem was caused by too much foremilk and I should keep him on the first breast longer. I'm trying to do this, but don't want to end up jeapordising his intake by not offering the second breast soon enough, particularly as reading on Kellymom etc. makes me think MW is wrong about this.

Does this sound like too much foremilk to you? And if so, how can I improve it? What I'm doing at the moment feels rather unnatural and forced and so I don't feel confident I'm getting it right, when previously I was really pleased with how it was all going.

I think that a sign of too much foremilk is green poo's.

If I were in your position I would contact a bfc and speak to the experts.

You should still be pleased with how things are going, it sounds like you are doing a great job. If there is a problem things can be easily tweaked.

sounds exactly like DS2. when he was about 3 weeks everytime he farted he pooed a bit to the point his bum was red raw and bleeding. we tried every cream in boots, cleaning with olive oil (not something i would recommend) creams from the GP etc etc. he used to scream in anticipation of having his nappy changed.

i eventually called NHS24 one sunday out of desperation and spoke to a wonderful HV who suggested that although DS2 didnt have thrush on his bum, he may have systemic thrush and i should reduce all processed food/sugar/bread from my diet. i went back to cotton wool and water followed by sudocrem and DS2s bum was healing within a couple of days.

HTH

Thanks both, that's very helpful. Fledtoscotland, did your DS2 stop doing the poo thing, or did his bum clear up even though it was still happening?

a combination of both. he was quite jaundiced and it all seemed to coincide that his bum was sore when the jaundice cleared.

i layered the sudocrem on (know you arent supposed to) so that i wiped off sudocrem with each nappy change and tried not to touch the skin as much as possible.

His poo improved as he got a bit older and by 5 weeks he was the opposite and was only going once every 4-5days (he was exclusively BF). I think his bum took about 10days to totally heal and the GP gave me 0.5% hydrocortisone to help once the initial anger had gone out of the wounds. I still think that the big difference was me cutting out yeast and sugar from my diet

further to what kazbeth said about cloth and disposable - the HV asked me what nappies i was using as apparently some of the supermarket own brands have chemicals. i always use huggies/pampers and she told me to stick to that.

i also did a strict regime of changing on the hour every hour. i couldnt always tell if he'd pooed esp overnight so i would change him every hour so that he wasnt sitting in it (every just a tiny smear)

Well, all of my 3 DSs had the symptoms you mention with the occasional green poo but mostly EVERY nappy, yellow, sometimes frothy, very explosive and seemed to have a lot of tummy discomfort (burping, farting, wriggling, turning away from breast at letdown).

I think the 'foremilk' argument is discredited now but there is an issue of 'oversupply' which some people think is valid - do you have a strong let down reflex and lots of milk perhaps?

I would recommend calling a BF counsellor. They do often recommend 'block' or single sided feeding as a way of balancing the milk supply (it stops you overproducing...)

You basically offer one side for a block of say 3 hours, and then the other side for the next 3 hours. You should only need to do this for a couple of days for things to level out.

But the key - to keep you happy - is to keep offering that side whenever they are in need: if they're really hungry, you will eventually get another letdown on the same side and there's always a bit of milk there.

Kellymom does have info on 'oversupply' and I suspect if you look it up you will find the indicators you mention are very similar. Good luck and please do get the support of a BF specialist also.

PS we went through every possible nappy rash option when DS2 had severe 'burns' on his skin: thrush etc, HC cream. In the end though, it wasn't thrush, which usually has a distinctive rash/chapping appearance, but WAS the constant acidic pooing that was doing the damage. We used a polymer spray called Cavilon to protect the skin (on recommendation of HV) in the end but this was a real last resort with open seeping wounds that wouldn't heal.

My ds is 5 weeks old and we have had exactly the same thing, but not one person has said the poos are a problem- not one midwife and trust me I have had loads to see me due to painful breastfeeding.

He sounds totally normal to me, mustard coloured poos every time he feeds, i think the poos are green if he is not getting the fat rich milk, but could be wrong.

The only thing that concerned me was the terrible nappy rash he had, which was red raw and agonising for him every time I cleaned it.
We have had 2 swabs done, treatment for antibiotics, thrush you name it, and it has only just started to subside, and I think it is happened as he has got "used" to the poos to be honest, and that his skin has toughened up.

We are still however, continuing with systemic thrush treatment for him (nystatin oral gel) and me (fluconazole) so it may also be a bit of thrush in his system.

I think as long as he is putting weight on, then to hell with what the midwife saysa about hind/fore milk.

One little tip, I use is when I think he has finished with the breast, I change his nappy and then offer the same breast again, he is more alert after the nappy change and generally will feed and empty it.
If it is "empty" or at least feels really soft, only then will I offer the second breast- its only happened a couple of times.
HTH

Ouch. Feeling sorry for the little babies with bad nappy rash after reading this Can I recommend something for it?

Get hold of pure shea butter, then do so - try ebay or another internet site if you can't find in a shop. It's got a sort of stiff greenish butter texture and smells horrible. Don't buy the stuff you get in Body shop that is just a cream with shea butter in it and dont buy anything with essential oils added.

You melt a big wodge down with some sweet almond oil (any health food shop or large supermarket should have it) in a pan and then leave the mixture to set. The almond oil has the effect of making the shea butter smell better and be more malleable. Apply this after every nappy change, it's fantastic, completely natural and incredibly good for the skin and doesnt sting. I also use it for all over baby massage as well.

Thanks again to all the new suggestions - really should get on to MN in the evening to see them all.

We are using Pampers at the moment, with a view to going into cloth (Fluffles) soon, though we are proceeding on that with caution because DS1 could never tolerate the cloth: it always gave him a rash, no matter what we tried.

Lupusinallamasuit, I've looked at some resources on oversupply and wondered about it. If so, it's incredibly ironic, since with DS1 everyone said my supply was utterly crap, they put me on domperidone and stressed me out no end about his weight gain. This is what makes me fret so about doing block feeding, because I'm fairly well programmed to believe that I don't have enough milk.

Will try to get to see a BFC - helpfully the MW is going to call on Baby Cafe day, so it'll be pure luck whether I can make it down there.

Thanks for all your help