Possible foremilk/hindmilk imbalance?

[@llli*drish10]

Hi,
I've been reading a lot about foremilk/hindmilk imbalance and it sounds like it might be a problem we are having. My 6 week old son is showing a lot of the symptoms but not all of them. He is having explosive green stools, but not all the time. Sometimes it looks like normal stools, only slightly green. He is so fussy between feedings and acts like he wants to eat all the time. But he doesn't have a diaper rash like I read is a sign of too much foremilk and he seems to be gaining weight normally, if not more than normal.

I started block feeding yesterday to solve the problem. But he uses a nipple shield despite weeks of trying to wean and I am worried he still isn't able to empty the breast and get enough hindmilk. I read that with the shield you need to pump after each feeding but I have not been able to do that since I am normally home alone with him all day and can't put him down after feedings to pump or else he cries. Is it true that the shield makes it impossible for the baby to empty the breast or is that something I shouldn't worry about?

I should also mention that I only pump once a day right before I go to bed to build up a freezer supply and when I do I pump anywhere from 6 to 12 oz. depending on the last time I nursed. I don't know if that is pretty average or way too much?

I just want to solve this problem. I can't handle him crying all day long, I want him to be happy! Please help!

[@llli*auderey]

My understanding is that if you're feeding often, on demand, then you really don't need to worry about the imbalance issue. 6 week olds want to eat all the time. That's normal. Not being able to put him down is also normal. Have you tried some kind of carrier so you can get stuff done around the house and go on walks? The fussiness may or may not be normal as well. it may be cured by carrying him.

Do you have OS/OALD? that might be a good reason to try block feeding. If I were you I would focus on getting him weaned off the shield (and i know others will join in here with some links from kellymom, please?) and stop worrying about the foremilk/hindmilk issue.

You are pumping A TON. Like, many moms only get 2 oz from a pump, total. This will be fabulous for your freezer supply (check now to make sure you don't have lipase). It's not "too much" unless it's causing other problems, and so maybe you do have OS and don't need to wrry so much about trying to pump after using the shield.

[@llli*mommal]

I was on the fence about oversupply until I read that you're pumping 6-12 oz at a time. That is way, way, way more than average, which as the PP said is closer to 2 oz per session.

OS would explain the explosive green poops and also the fussiness between nursing sessions, since an overabundance of so-called foremilk can cause a lot of gas and discomfort. It may also explain why you are having trouble getting rid of the shield: when a mom has a large milk supply the milk tends to come out quite fast, something which can be ameliorated by the presence of the shield. Fast letdowns can also be slowed by baby clamping down on the nipple, which can cause mom to reach for the shield in the first place.

Since your baby's poops are only sometimes green, I don't think you need to do anything except try to ditch the shield, stay away from the pump, and feed on demand. Frequent feedings are ideal when dealing with oversupply and fast letdowns, since letting the breast fill up with milk by going a long time between feedings will result in a faster letdown, more "foremilk" intake, and more discomfort for baby.

Let me digress for a moment and talk about some common misconceptions about foremilk and hindmilk. First, there's no such thing as foremilk and hindmilk. The breast only makes milk. The milk that comes out at the beginning of a feeding is watery, refreshing, relatively low in fat and high in lactose (milk sugar). As the feeding progresses, the milk becomes progressivey creamier. Often you will hear people talk a lot of trash about that watery, sweet foremilk, like it is somehow bad for baby. Well, it's not! It is normal for baby to consume a certain amount of foremilk, and foremilk contains all the elements necessary for normal growth. In fact, babies whose moms have oversupply, and who therefore consume a lot of lactose-rich, lower-fat milk, tend to grow very quickly, particularly in the early days when oversupply tends to be more extreme. The only problem with foremilk is the lactose: a lot of extra lactose in baby's diet can cause a certain amount of gassiness and intestinal irritation, and therefore green poops. But those things are not a big deal, and will pass with time as your milk supply adjusts to meet baby's needs more precisely.

Nurse on demand, stay away from the pump, ditch the shield!

[@llli*lllmeg]

Drish10 said:

I read that with the shield you need to pump after each feeding but I have not been able to do that since I am normally home alone with him all day and can't put him down after feedings to pump or else he cries. Is it true that the shield makes it impossible for the baby to empty the breast or is that something I shouldn't worry about?

The shield (or whatever issue may have caused a mom to need a shield) CAN cause these issues. So the typical recommendation is to pump when using one (and to keep a close eye on baby's weight gain as well.) But it is not always neccesary, this is another one of those things that is very individual. If baby is gaining well all is likely fine. Personally I DID pump after every session while using a shield and ended up with enough milk for twins.

Has the initial reason you were using a shield been solved? Sometimes when a mom has oald, the baby prefers to nurse with a shield because it tames the flow a bit. Could that be going on? In your case, since it does not seem to be causing any supply or weight gain issues, there is no reason to stress unduly about using the shield, but life will be way simpler for you when you can nurse without it.

Mommal said:

Let me digress for a moment and talk about some common misconceptions about foremilk and hindmilk. First, there's no such thing as foremilk and hindmilk. The breast only makes milk. The milk that comes out at the beginning of a feeding is watery, refreshing, relatively low in fat and high in lactose (milk sugar). As the feeding progresses, the milk becomes progressivey creamier. Often you will hear people talk a lot of trash about that watery, sweet foremilk, like it is somehow bad for baby. Well, it's not! It is normal for baby to consume a certain amount of foremilk, and foremilk contains all the elements necessary for normal growth. In fact, babies whose moms have oversupply, and who therefore consume a lot of lactose-rich, lower-fat milk, tend to grow very quickly, particularly in the early days when oversupply tends to be more extreme. The only problem with foremilk is the lactose: a lot of extra lactose in baby's diet can cause a certain amount of gassiness and intestinal irritation, and therefore green poops. But those things are not a big deal, and will pass with time as your milk supply adjusts to meet baby's needs more precisely

Well said!

[@llli*drish10]

Thanks for all the information!

I am not sure if I have a fast let let down. He has never nursed without the shield but every once in a while he will kind of choke and he always has a ton of milk running down his cheek. I was given the nipple shield because I had inverted nipples but I don't think that a fast let down is the reason he won't nurse without it because I have never gotten him to try nursing without it. I have tried everything: taking it off at different times during the feeding, expressing a little milk and putting it to his lips, taking baths with him, skin to skin... The most he will do is latch on and take a suck or two and then pull away and that's only happened a handful of times.

When you say stay away from pumping does that mean all pumping? Even just once a day for freezer supply?
Also, is there anything I can do about his fussiness? People keep reccommending drops you can use for gassiness and colick. Would that be appropriate and safe in this situation? He just cries all day long and it seems like there is no way to get him to stop.

[@llli*lllmeg]

The issue with pumping is, if done over and above what baby needs each day (in other words, on top of exclusive breastfeeding) it can cause/exacerbate oversupply. If you do not have that, and you need milk for a freezer stash, then I don't see why you should not pump- with caution. if you do have oversupply, again, if you need the extra milk in the freezer, then pump-but as infrequently as possible and with caution.

You say:

He has never nursed without the shield but every once in a while he will kind of choke and he always has a ton of milk running down his cheek.

and

The most he will do is latch on and take a suck or two and then pull away and that's only happened a handful of times.

Those issues are consistent with overactive letdown and oversupply. As are the green explosive poops and the massive pump output.

As far as weaning off the shield-do you want to? If you are happy using the shield, that is fine. Long term, again, the concern is that shields can affect a baby's weight gain and your milk supply. But if you keep an eye on that it may be fine. You just want to be aware of the potential for problems.

Are your nipples still inverted? pumping and nursing often 'fixes' this over time. If they are able to protrude enough now, then baby should be able to nurse without the shield. Weaning off the shield can be a slow and frustrating process, but usually possible. What I was thinking is perhaps baby needed the shield initially due to the inverted nipples but now it's more due to not liking a fast letdown. It's really just a theory.

good article on oald and os, http://kellymom.com/bf/got-milk/supp.../fast-letdown/

and nipple shields: http://kellymom.com/bf/concerns/child/wean-shield/