OALD vs. Oversupply

[@llli*desertchildaz]

My 3 week old has been vomiting a significant amount of milk through his nose and mouth after nursing on my left breast. I had suspected OALD or Oversupply.

He tends to be very noisy when feeding off that side...gulping and gurgling. He will also sometimes scream while still latched and appear almost pissed off but doesn't pop off. Just grunts loudly. While that side appears to fill up and become almost engorged and leak, it doesn't seem to squirt him. I should note that, as with my last pregnancy, I have no idea when I letdown. I don't feel anything different that would signal a letdown. So I don't know if that grunt is happening when I let down or if it's unrelated to letdown.

Over the past 24 hours, I've noticed that his usually mustard colored stool is now sprinkled with specks of green stool.

As an experiment, at around midnight last night I pumped the left breast and found that the milk was very watery (not thick or fatty). I wanted to see how much he would have to eat before getting to the hindmilk or fatty milk. I pumped 3 ounces before stopping and still no lipase. (I could have pumped much more from that breast...but stopped there to avoid instigating overproduction and worsening the problem.) The 5 oz. bottle I pumped from the right breast the previous night was very thick with lipase or fatty milk compared to this 3 oz. from the left breast.

I have been trying to feed him at a 30 degree angle and will take him off the breast to burp him occassionally before putting him back on. I've also been feeding himon the right breast for 2 or 3 feedings before moving him to the left, expressing the left by hand when it starts to feel engorged. But, honestly, I'm almost afraid to feed him on the left when the time comes because I don't want him to throw up.

Obviously, my first priority is to prevent him from vomiting so he doesn't lose that nutrition. Then I have to figure out how to increase the lipase production in my left breast. Any thoughts or suggestions?

[@llli*mommal]

My suggestion: relax. He's 3 weeks old. It's probably too early to be worried about any of this, and he's having predominantly yellow poops as of this moment. If you just feed on demand, your supply will probably eventually adjust to be just right, and all of your concerns will become academic.

When a baby is coping with OALD, your first concern should be his comfort. You want to adopt reclined nursing positions and see if that helps slow the flow- and it usually because of our old friend, gravity.

Spit-ups aren't a concern unless the baby seems to be in pain when spitting. If he's not, spit-up is a laundry issue, not a health problem. Your LO will not "lose" nutrition because he spits- he'll still keep plenty in is tummy. All he's losing is the excess milk that was making him overfull.

[@llli*esthervegan]

Yes to everything Mommal posted.
my ds3 spit up copious amounts of milk. I wore a trail of baby puke and spit up down my back for months.
I was very committed to nursing from only one side per feeding. That did work to regulate my supply.

[@llli*joe.s.mom]

As mentioned on your other post, I'm dealing with some similar issues, but having gone through really extreme oversupply with my first baby, hadn't really given these milder symptoms much thought this time around. When your milk supply is plentiful and the flow is strong (OALD), babies will often spit up a lot more and a lot more dramatically (through the nose is normal, if a bit hard to watch! ). If this isn't accompanied by distress and colic symptoms and the baby is basically pretty happy, I honestly wouldn't worry about it at all. If it is, I'd try laid back positions, etc.

If your baby's poops are yellow and seedy, I wouldn't worry about foremilk/hindmilk balance at all. I wouldn't worry about the occasional green poop, either. When I had OS with Joe, his poops were universally green and frothy (and I was pumping like 10-12 oz a day on top of nursing all the time) so it was more than just an occasional thing.

[@llli*desertchildaz]

I would not be concerned about "spit ups", but these are full on vomits...out his nose and mouth and the equivalent of what appears to be about 2 ounces. As if you've spilled an open bottle....it's also mostly the translucent milk (not the thick, curdled looking milk like you see in spit ups.)

I did try the reclining tummy to tummy hold and he still threw up but not as much. And he seemed to struggle with staying on the nipple.

Edit added: Joe.s.mom: I did not see your post until after I posted this. I was just replying to Momma! with this post.

[@llli*joe.s.mom]

Could he have some reflux? ETA: I'd be more concerned about a lot of projectile vomiting especially if accompanied by distress. Again, even if the spit ups/vomits are huge and dramatic, if baby is basically happy, I wouldn't worry. Maggie spits up milk right after eating all the time (non-curdled), but it doesn't seem to bother her, so it doesn't bother me. Her diaper output tells me she's getting enough.

[@llli*lllmeg]

is your baby gaining as expected? even giant spit ups are almost always entirely normal. my eldest did the type you describe all the time. it could be aome slight oald, and does not hurt your baby in the least. he is not losing nutrition, he is getting rid of what he does not need at the moment the way nature intended.

you could try the many ways to improve oald that does not involve messing with your milk production, as that could help and won't hurt. and if that does nothing after a week or more, consider block feeding, but be very careful and start slow in early days. remember all your milk is good for your baby and one of the best ways to deal with oald is to nurse very frequently. and stop pumping! That’s the last thing you want to do with oald or os.

http://kellymom.com/bf/got-milk/supp.../fast-letdown/

[@llli*desertchildaz]

Okay, I'm going to have to take your advice and relax. The vomiting is just so unnerving and makes me worry that he's not getting what he needs nutrition-wise but he has been gaining, so I'm not going to worry about it for now. I'll just continue to feed him normally and use some of the tips in llmeg's link. If I don't see improvement in a week, I'll go back to block feeding him. However, I do still have concerns about the lack of lipase in the milk of the left breast. As it is now, he's not getting "full" or satisfied on the milk from that breast and it will leave him hungry for more in no time. (This explains his demand to nurse 20 minutes after feeding on that side).

As for pumping, I've been pumping at least once per day (5 oz.) to build up a freezer supply for when I go back to work in September.

[@llli*mommal]

The left breast doesn't lack lipase. Lipase is an enzyme that breaks down fat. It's a tiny molecule and you can't see it in expressed milk- though moms with excess lipase will tell you that you can eventually taste it in expressed milk, since it produces a nasty soapy flavor.

It sounds more like your concern is about the amount of fat in your milk. If you have some oversupply issues, it's normal for the milk to look quite thin and watery. But that doesn't mean it lacks fat. Fat and fat-soluble elements are present in all of your milk, and that includes the so-called "foremilk". It's just that the first milk that comes from the breast is relatively higher in water and carbohydrates than fat, and therefore it appears more watery. This watery milk is not bad for your baby, though it might make him a bit gassy.

It can be tricky to draw conclusions about supply and fat content based on expressed milk. The amount of milk you produce and the amount of fat in the milk will vary based on when you last nursed, the time of day, and your responsiveness to the pump. That's why it's usually better to base your conclusions about your milk on your observations of your baby. If he's growing well and seems happy and healthy, then there is no reason to be concerned, no matter what you're seeing or not seeing in the bottles.

[@llli*phi]

with everyone else.

I just wanted to respond to this:

As for pumping, I've been pumping at least once per day (5 oz.) to build up a freezer supply for when I go back to work in September.

LLLmeg is completely correct, of course, the very worst thing you can do for overactive letdown and oversupply is pump. If you are away from your baby 10 hours your first day back to work, then the absolute maximum he will need is 15 ounces. It's nice to have a couple extra bottles; so you should be fine if you have saved about 20 ounces, which you would have pumped in 4 days if you have been pumping 5 ounces a day. Now is a good time to stop. Even if you are not there yet or you would like to sock away a little more you can resume pumping in the week or 2 weeks before you return to work, and have a very nice freezer stash going.

Three weeks is really too early to be pumping, and it will only make things much, much worse. Quit pumping before you worry about block feeding (pumping often negates block feeding anyway: block feeding says make less milk + pumping says make more milk = no change). Nursing on demand without pumping is the very best way to get your milk supply to sync up with your baby's needs.