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Thread: Increase or decrease pumping frequency for a sick baby?

  1. #1
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    Default Increase or decrease pumping frequency for a sick baby?

    Hello,

    This is my first post but I have been reading forums since my daughter was born 8 months ago. It will be a long one, so sorry about that but my story is complicated and I need your help!

    Here’s some background - LO has been refusing breast occasionally since she was born, and it’s always around my ovulation and a week into my period (I got my period when she was only 2 months , calcium+magnesium+zinc supplements didn’t help much). I had 3 bouts of mastitis so far, two treated with Clindamycin. LO started to poop green and slimy with streaks of blood when she was 2,5 MO and every ped I met said it’s probably cow milk protein allergy. Even though I didn’t believe it, I went on dairy free diet. It took almost 5 months before the poor thing was diagnosed with pseudomembranous colitis caused by Clostridium difficile infection. FYI Clindamycin is known to propagate infection and she probably got the bacteria back in the hospital during delivery. The next person who tells me that green poop is normal is getting a punch in their face!

    Anyway, to cut the story short, she started to stagnate in weight and height because of the illness. My supply has been reduced because she seemed to have lost appetite over time (I always nursed on demand) so I started to pump 10 days ago instead of feeding hypoallergenic formula like pedi suggested (it’s the most disgusting thing I ever tasted in my life!). I rented a single electric pump at the hospital (double electric is not available where I live, I am not from the US and we don’t have lactation consultants here sadly). This is my pumping/nursing schedule (total volume expressed from both breasts, I measure in ml so fl oz units may not be accurate):
    1AM nurse
    5AM nurse
    8 AM 7-8 oz (or 200-250 ml) 30-40 minute session
    11 AM 3,5-5 oz (120-140ml) 20-30 min session
    2 PM 3,5-4,5 oz (around 100ml, add or remove 20ml) 15-20 min session
    5 PM 3,5-4,5 oz (around 100ml, add or remove 20ml) 15-20 min session
    7PM nurse during the nap nap
    9PM nurse to sleep

    So I pump nearly 0,5 liter in total during those 4 sessions.

    Since I started to pump, I am waking up mildly engorged. She refuses breast completely during the day but takes a bottle after some convincing (I always offer 120 ml, she eats anything between 60 and 110ml, 400 ml in total per day plus I nurse 3-4 times afterwards, I freeze the leftovers). She gets solids twice per day, fruits, veggies or iron fortified baby cereal as per pedi's recommendation but doesn’t eat much because of the illness. Regardless, she is still 90 percentile for height, weight and head circumference (the reason no one believed me she was ill!). She wets at least 5 diapers now that she got treatment, is still taking antibiotics. I don't think she is teething.

    I am at my limits from worry and stress, so I am just wondering if I am doing things right. I pump until the last drop plus a few minutes to stimulate breast. I use medium shield, it starts to get uncomfortable by the end of the session, a bit of areola gets into the tube on one side but it's tolerable. I tried fenugreek but to my surprise – my pumping output was reduced when I started to smell like maple syrup!?! Fennel and oatmeal helps though, I start feeling milk let down sooner. I also use Syntocinon nasal spray for pumping, it made a big difference for me. I did everything to put LO back to breast for past two months but it started to be a torture for both of us and I didn’t want to stress her anymore since she was sick and probably exhausted from pooping all that slime and blood. Since I have no access to double electric pump, I have to start from one breast but I alternate breast I start from at the beginning of every pumping session.

    Am I doing this right, ladies? Am I pumping enough to maintain good supply? Is it OK to pump every 4 hours instead of every 3, my nipples are sore since I went suddenly from EBF to part time pumping. I used to nurse off one breast per session, she always refused the other one. I can’t judge by the baby’s intake since she is sick, next checkup is in 3 days. Please help me with your experiences, I feel desperate and scared of the 4th mastitis !

    Thank you so much in advance!
    Last edited by @llli*undergroundmuse; April 14th, 2014 at 08:52 AM.

  2. #2
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    Default Re: Increase or decrease pumping frequency for a sick baby?

    Hi mama, welcome to the forum! I am so sorry about your baby's bout with C. diff. Has anyone suggested a stool transplant for her? This is a decent link: http://en.wikipedia.org/wiki/Fecal_bacteriotherapy

    The amount you're pumping, about 0.5 l per day (approximately 17 fluid oz, for the US LLLadies), sounds about right. On average, a breastfed baby requires. 19-30 oz (562-887 ml) per day to get all her nutritional needs met by breastmilk alone. Since your baby is older, and eating some solids, and breastfeeding 3-4 times per day, it makes sense that she's taking around 400 ml per day from bottles. Keeping your pump output slightly ahead of her bottle intake is a great idea, because pumping is generally less effective at maintaining supply than nursing. Running a small surplus is to your advantage.

    Pumping less frequently will probably result in lowered supply and also increases your chances of coming down with mastitis again, so I wouldn't do it. But I would look into using different sized shields- perhaps that is why you are getting sore?
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  3. #3
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    Default Re: Increase or decrease pumping frequency for a sick baby?

    Thank you so much for reply mommal!

    Yes, husband and I are aware that fecal transplant can be done, but it seems like medical professionals don’t do it here . I probably cannot be a donor due to the Clindamycin treatment I had in past. Pedi said they don’t treat Clostridium unless it’s symptomatic. But we give her probiotic/Lactobacillus drops for babies, it cannot harm in any way. She poops less and it’s not green and bloody any more at least. I hope it won't return.

    So we had a checkup yesterday, LO is apparently feeling better and she gained amazing 400g in past two weeks! She now weights 9355g. However, her hemoglobin could be better, it’s 116 now. I don’t know about the unit but the lower limit is 106. She used to have 124 two months ago. Time to introduce beef into her diet I guess. She felt so much better that she learned how to crawl the other day and she actually took a ball made of beef and rice I gave her, put in her mouth, “chewed” and swallowed! I think I will give her more solids from now on, I don’t know for how long I can keep this pumping schedule, I am so stressed. LO gets frustrated whenever I offer breast .

    My pumping output is lower in the morning now, I went down to 160ml today but I consistently pump 100ml every third hour after this. Could it be that LO eats more at night? She wakes up twice at night lately and still takes about 400ml EBM in a bottle.

    I use Ardo Calypso pump and it’s the best I ever tried, 26mm shield. I have Medela Freestyle which I really hate because I never pumped more than few drops even with different shields (very bad investment IMHO). Philips Avent gave me sore nipples and it’s not good for long term use anyway. There are only larger shields for Ardo Calypso available and I think I need a smaller one.

    Any ideas what to do? Are there universal "adapters" for smaller nipples that one can put inside the existing shield? I couldn’t find any online .

    Also is fennel safe to take for prolonged periods of time? I am not sure but I think I read on KellyMom that it’s okay for two weeks. Does anyone know?
    Last edited by @llli*undergroundmuse; April 17th, 2014 at 04:22 AM.

  4. #4
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    Default Re: Increase or decrease pumping frequency for a sick baby?

    Yes, husband and I are aware that fecal transplant can be done, but it seems like medical professionals don’t do it here
    I think that's typical everywhere- it's still considered experimental and the "ick" factor alone seems to be deterring use of the technique. You might want to look around for a doctor who is a little more open-minded, and see if someone will at least discuss the possibility. It's not like it's a hard procedure to perform- not in my understanding, anyway...

    However, her hemoglobin could be better, it’s 116 now.
    All that blood loss from the C. diff., I'm not surprised...! There are some ways to feed your LO iron-rich foods that don't necessitate feeding her beef, like lentils and beans, blackstrap molasses, leafy greens, and dried apricots. I'd be a bit reluctant to offer beef unless it was really super-organic. It's not like she needs more antibiotic residues, right? IDK, maybe that's an overcautious thought on my part!

    I think I will give her more solids from now on, I don’t know for how long I can keep this pumping schedule, I am so stressed. LO gets frustrated whenever I offer breast .
    I'm so sorry about the breast refusal. It's so hard not to feel utterly rejected.

    I know keeping up the pumping schedule is really hard. If you decide to drop down to a lower level, just remember that breastfeeding isn't all or nothing. Even if you provide your child with just one bottle per day of breastmilk, or even just 1/2 a bottle, she is still getting a lot of health benefits from that.

    My pumping output is lower in the morning now, I went down to 160ml today but I consistently pump 100ml every third hour after this. Could it be that LO eats more at night?
    She is still nursing at night, right? If so, I would encourage you to nurse her as much as possible at night. Sometimes that can help a baby remember that nursing is nice and make her decide to try it during the daytime, as well.


    Any ideas what to do? Are there universal "adapters" for smaller nipples that one can put inside the existing shield? I couldn’t find any online .
    I think so, but I don't know what they're called. I would start a new thread in the pumping subforum.

    Also is fennel safe to take for prolonged periods of time? I am not sure but I think I read on KellyMom that it’s okay for two weeks. Does anyone know?
    This is a medical question, and therefore we can't (and shouldn't) answer it. Am your doctor or midwife, and if you can afford a long distance phone call, the Infant Risk center would be an excellent resource: http://www.infantrisk.com
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  5. #5
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    Default Re: Increase or decrease pumping frequency for a sick baby?

    Quote Originally Posted by @llli*mommal View Post
    I think that's typical everywhere- it's still considered experimental and the "ick" factor alone seems to be deterring use of the technique. You might want to look around for a doctor who is a little more open-minded, and see if someone will at least discuss the possibility. It's not like it's a hard procedure to perform- not in my understanding, anyway...

    An open-minded one, I feel very discouraged now... I will bring it up but I really doubt anyone here would even cosider it as an option.

    Quote Originally Posted by @llli*mommal View Post
    All that blood loss from the C. diff., I'm not surprised...! There are some ways to feed your LO iron-rich foods that don't necessitate feeding her beef, like lentils and beans, blackstrap molasses, leafy greens, and dried apricots. I'd be a bit reluctant to offer beef unless it was really super-organic. It's not like she needs more antibiotic residues, right? IDK, maybe that's an overcautious thought on my part!
    No, I agree, I buy only organic and free range for LO. I will try with iron fortified oatmeal porrige, beans and egg yolks too.

    Quote Originally Posted by @llli*mommal View Post
    I'm so sorry about the breast refusal. It's so hard not to feel utterly rejected.

    I know keeping up the pumping schedule is really hard. If you decide to drop down to a lower level, just remember that breastfeeding isn't all or nothing. Even if you provide your child with just one bottle per day of breastmilk, or even just 1/2 a bottle, she is still getting a lot of health benefits from that.
    The other day we gave her 1/2 oz formula to see how she reacts. We found blood on her dipers later :/. I now think she might be both allergic and sick. That's what makes me feel stressed, I don't know if I will always have enough EBM and there is no backup option. I barely know anything about formulas and I hate having to give them. What to feed my LO then? I have a very humble freezer stash, had to discard the old one since it was possibly contaminated with antibiotics and milk protein . If only we could last until I can rely more on solids, that would be great. But pumping is driving me literally insane, and breast refusal during the day extremely sad.

    Quote Originally Posted by @llli*mommal View Post
    She is still nursing at night, right? If so, I would encourage you to nurse her as much as possible at night. Sometimes that can help a baby remember that nursing is nice and make her decide to try it during the daytime, as well.
    I could never encourage this baby girl to do anything she didn't want to... It's always when she wants and how she wants. I think she is way too used to the bottle now since I have been desperate and wanted her to get at least some EBM while being sick. I nurse her only at night now, 2-3 times, not more than that. I tried so hard and so for so long.


    Quote Originally Posted by @llli*mommal View Post
    I think so, but I don't know what they're called. I would start a new thread in the pumping subforum.
    Will do, thanks!

    Quote Originally Posted by @llli*mommal View Post
    This is a medical question, and therefore we can't (and shouldn't) answer it. Am your doctor or midwife, and if you can afford a long distance phone call, the Infant Risk center would be an excellent resource: http://www.infantrisk.com
    I will see to give them a call then. I have been using fennel sometimes since she was 4MO but never longer than a few days. It's been over two weeks now so I am getting worried.

    Thank you mommal.

  6. #6
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    Default Re: Increase or decrease pumping frequency for a sick baby?

    I know it must be extremely hard to be worrying about what you will feed your baby if your milk runs out. I'm so sorry you had to toss your stash. At this point, I think it might be worthwhile to look into donor milk- available through milk banks or from trusted donors- and talking to your pediatrician about what formulas to use if baby has an allergy to the ordinary stuff. I know that there are formulas made for very allergic babies (e.g. Alimentum, Nutramigen), and if you need to supplement that might be the way to go.

    Regarding finding a doc who is willing to at least discuss the possibility of a fecal transplant, you might simply want to google "stool transplant Sweden". I did that and found some likely avenues...
    Last edited by @llli*mommal; April 19th, 2014 at 11:27 AM.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  7. #7
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    Default Re: Increase or decrease pumping frequency for a sick baby?

    Here's an update (perhaps some mom may find it helpful in future): expressing 600ml now with one additional session in the evening, re-building a stash. Discontinued fennel for now. LO's intake slightly reduced, blood in the poop found again :-(. Trying to encourage her to reverse cycle, no luck for now. Calling pedi tomorrow and planning to give a call to a person knowledgeable in fecal transplantation. Lactobacillus reuteri drops provide some relief, but I speculate that my breastmilk kills them. Ordered saccharomyces boulardii for babies, pubmed search indicates that this yeast helps reduce the chances of c. Diff relapse.
    Last edited by @llli*undergroundmuse; April 21st, 2014 at 02:52 PM.

  8. #8
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    Default Re: Increase or decrease pumping frequency for a sick baby?

    Quote Originally Posted by @llli*undergroundmuse View Post
    Lactobacillus reuteri drops provide some relief, but I speculate that my breastmilk kills them.
    Much more likely that the baby's stomach acid kills them. Breastmilk is actually a known prebiotic- that is, it contains substances, particularly oligosaccharides, that are designed to feed a healthy microbiota in the baby's gut. This is why moms who are confronted with C. diff should be advised not to wean: a breastmilk diet provides the perfect substrate for the healthy gut bacteria that you want to reestablish.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  9. #9
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    Default Re: Increase or decrease pumping frequency for a sick baby?

    Update, LO got Flagyl, 2.5ml x 3 instead of 6ml x 1 as previously. C. Difficile bacteria and toxins a and b were found in feces sample. Pedi discouraged us from fecal transplantation. I feel depressed and utterly rejected, no daytime nursing any more, nursing to sleep in the evening is getting difficult. So sad, i thought lo would nurse for comfort at least but it's just wishful thinking on my side. Lo always has bowel movements when nursing which are probably uncomfortable so i guess she developed aversion to nursing due to the illness.
    I rented another pump so i can double pump now. The midwife who gave it to me kept her eyebrow raised, but gave me a number to call in case i can donate. Building up a freezer stash.

  10. #10
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    Default Re: Increase or decrease pumping frequency for a sick baby?

    Mama, you are working so hard and you should be so proud of the way you're caring for your baby.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

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