Low milk supply at 20 months
I'm hoping someone can help. My 20 month old (who I am home with) "nurses" about 3-4 times per day (morning, before/after nap, once in the later afternoon and at bedtime). I say "nurses" because for the past couple months despite my attempts to drink like a racehorse and eat as normal as possible it seems that my son only really gets a good nursing session in first thing in the morning. There are swallows here and there for his other sessions but I'm nervous that he is really only getting 1 good nursing in a day. So, my questions are:
1) I hadn't been giving him much cow's milk (he will eat an ok amount of cheese and occasionally yogurt) because I had read that he doesn't need it with other dairy if he is nursing 3-4 times a a day but now I am sure he really isn't getting enough mom's milk and that I should really be giving him cow's milk (which I am not opposed to, just didn't think he needed it). He was always a big boy but has barely gained any weight in almost a year. I know he is "slimming down" but the doc wanted to keep an eye on it after he had dropped quite a bit percentile wise at his 18 month appointment. He is growing taller just not much heavier. So - how much cow's milk should I give him? Should I be worried about his weight?
2) Is there anything I can do/should do to increase my milk at this stage? I had low milk supply from the start (it was unclear how low because my son had a tongue tie and bad latch) so I took fenugreek/blessed thistle but that caused him to gain a LOT of weight and I don't think we need/want to go back there. I also am not so interested in taking domperidone. However I also don't think that eating oatmeal or any of those things will really help. Should I go to these lengths to make sure he is getting a bit more milk while he is still nursing? I really wanted him to get more mommy milk than cow's milk even at this stage but now I'm really starting to worry about his weight and want to change something.
Thoughts? Sorry this was long! Hope it was clear. :)
Re: Low milk supply at 20 months
The best thing you can do for supply is to nurse frequently and to have a child who is nursing well. You could offer the breast more often, but at 20 months your child might or might not be interested in nursing more, and when he does nurse, he might not be that effective. A lot of older babies transition from nursing for both food and comfort to nursing primarily or even exclusively for comfort. They don't really care whether or not they get a lot of milk when nursing.
At this point, I think it's a great idea to introduce a bit more dairy to your child's diet, but keep in mind that "dairy" doesn't necessarily mean "cow's milk". You can offer drinkable milk but it's just as good to offer cheese and yogurt made from whole cow, goat, or sheep milk. Better in some cases, because not all kids like animal milk in a cup.
When it comes to the amounts you should be offering, I think the guidelines vary somewhat, depending on who you ask. but they seem to cluster around offering around 2 cups of milk or yogurt per day, or 1.5 oz of cheese. Not that much, relative to the size of the child. My guess is that offering liquid milk is not going to make much of a difference in your baby's weight gain.
Whether or not you go to great lengths to increase your own milk supply is really up to you. I personally wouldn't- it would be too much effort for too little gain, when I could just as easily offer animal milk in addition to my own. But that's me, and you're you! So do what feels right to you. :)
Re: Low milk supply at 20 months
I find the nursing sessions that are most effective in regulating my supply are the nighttime ones. If I notice my supply dipping, I'm diligent about ensuring DS-almost-29mo, who cosleeps with me, nurses on both sides at each waking. He still likes to nurse 2 or 3 times each night.
If your LO is receptive to, say, homogenized milk, I'd add an 8oz glass a day with a snack of 1/2 to 1 oz of cheese and see how things go. If you're not averse to night nursing, ensuring you get in one good overnight session on both sides will significantly increase your LO's intake of your milk while allowing a gentle transition to complementary foods. :)
If you're concerned about weight and dairy, I'd add some 18% cream to anything saucy or porridgey your DS eats. Having spaghetti with a tomato meat sauce? Make his a rose with a tablespoon or two of cream and a sprinkling of cheese. Make scrambled eggs with one whole egg and an extra yolk (great for choline) and 1/2 tbsp of cream. Add a cream sauce to plain foods, and you can make a basic roux into a Mornay sauce by stirring in grated cheese. In a consequence free world, I'd eat rich omelets every day and sauce wildly. ;)
For 1 cup of roux, melt 1 Tbsp of butter in a pan and stir in 1 Tbsp of flour until a paste forms. Whisk in 1 cup of cream, stirring constantly over medium heat until it thickens enough to coat the back of a spoon. For a Mornay, sprinkle in 1/2 cup of your favourite cheese and whisk until it melts.
Another idea is to dip pieces of fruit into a full fat plain yogurt, or veggies into a yogurt based dip. If he's into yogurt, opt for a high fat Balkan style yogurt.
I struggle with keeping my son's weight up and having him eat. When you think of it, for a child to put on an extra half pound of weight per month (effectively, the TOTAL usual growth expected), he needs about 70kcal in addition to his existing diet. In dairy terms, that's one ounce of cheese, 2 Tbsp of cream, 1/2 cup of homogenized milk, or 1/2 cup of high fat yogurt. When you think of making the change in baby steps, achieving the change becomes much easier. For example, I've instituted a goal this month of having my son eat 1oz of cheese each day and an extra 1/4 cup of fresh fruit. That's 2 snacks with 3 bites of cheese and about 3 bites of fruit each. 6 bites at a time is doable, even for a sensory guy like my son who likes to eat on the move!