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Thread: Help: Clarifying Forceful Letdown / Oversupply versus MSPI

  1. #1
    Join Date
    Nov 2014

    Default Help: Clarifying Forceful Letdown / Oversupply versus MSPI

    My LO is almost 7 weeks old, and I'm trying to figure out what's going on with his occasional green and/or mucousy diapers. I'm new to the forums (and a first-time mom), but I've read a lot of posts about oversupply, forceful letdown, and MSPI. I can't find a lot, though, on figuring out which is the case - like how often would the diapers be greenish / mucousy if it's MSPI? (Or neither? I've also read that green can be a normal hue). This is a long post, but I'm not sure which details are or are not relevant (thanks in advance for reading!).

    I'm intent on EBF, but I return to work in a week, so I will have to pump part of the time. I currently pump ~ once per day, and get 4 oz per breast in 4-5 min.

    My LO is a very happy baby; he's alert when he's awake and sleeps well. He sleeps 2-5 hours a time at night depending on how gassy he is (sometimes I fall asleep while he's nursing so he doesn't get burped right away ), and he always wakes up bright eyed and cheery. He only fusses a few minutes a day. If it weren't for the color of his poop occasionally, I wouldn't even think there was a problem. He seems to have intermittent congestion, but it's more like boogers & sometimes a rattly sound in his breath - he doesn't usually have any mucous or runny nose. Oh and his weight gain is great. He's put on ~ 4 lbs since birth.

    Out of about 9 diapers a day, 0-3 of them may have a green shade to them (like the ugly green-yellow crayons, not bright green or dark green) and/or have a few stringy things or glistening appearance (I think mucous) -- this started about 3 weeks ago. He passes a fair amount of gas, and when I'm burping him he sometimes sounds almost like an adult - loud, and substantial. When he's burping or passing gas he frequently doesn't seem to notice / care, and otherwise only fusses minimally. There's no rashes that I can see (he has baby acne but that's it); he doesn't scream, or have any colicky periods, trouble sleeping, etc.

    The part that seems related to food:
    He ALWAYS is gulping when he nurses, and frequently will pull off mid-session wheezing or gasping for air, coughing, or even choking & sputtering. He may finish, or stop, and cry or get angry but it's always when he's choking or clearly overwhelmed (milk will sort of squirt back out of his mouth as soon as he releases the nipple). This continues even though I try nursing him from a reclined position so he's atop the breast. He spits up (most often if I don't get a burp out of him after eating), but doesn't mind and it's not forceful. Feedings are usually 3-9 minutes, and only go longer if he's "tanking up." He only ever feeds on one side at a time. Oh and he eats 12-13 times a day (once or twice in the middle of the night).

    I leak horribly. When he pulls off mid-session, if I'm not quick with a burp rag, I'll drain all over my clothes (it just flows/sprays out on its own). My let-down is frequently painful, and happens if its been a couple hours since he nursed that side OR if he's nursing on the opposite breast.

    I feel like this probably isn't a MSPI issue, but I feel guilty that I might be subjecting him to something he's allergic to. At the same time, with heading back to work and still recovering and being tired, the idea of going dairy & soy-free just to see seems really daunting. For the experienced moms - is MSPI something that makes all diapers funky, not just a few? How green is "green meaning MSPI" versus "green as a normal variation?" Am I risking something bad if I delay going dairy/soy-free and it turns out that's the case? Is there any way to confirm if it's a letdown issue instead? Any advice is appreciated. Thanks

  2. #2
    Join Date
    Jun 2009

    Default Re: Help: Clarifying Forceful Letdown / Oversupply versus MS

    Hi and welcome! OK, you stumped me and I had to look it up. MSPI="Milk/soy protein intolerance."

    When a child has a sensitivity to a food protein from their mothers diet, it rarely shows up only as a poop look issue. There are often at least some other symptoms- rash, poor weight gain, excess fussiness, unusual sleep disturbance...

    The other issues you are having sound like forceful letdown and possibly overproduction.

    Baby is already nursing with good frequency, which is always my first suggestion for fast letdown-nurse frequently and one side at a time. Of course, it will not hurt and may even help to offer to nurse even more frequently.
    Have you tried nursing in a more leaning back position to help baby handle the flow? What about hand expressing a little prior to nursing, or easier yet, taking baby off when the flow is very fast and then putting baby back on when it slows? These things help with fast letdown in most cases.

    The possible overproduction- what have you heard about block feeding? This is usually an excellent way to reduce production. But it is vital it be done only when mom REALLY has overproduction AND baby is gaining very fast. 4 pounds in 7 weeks is great gain- but is it unusually fast? Not all that much I do not think...1/2 pound a week is the norm. But it depends on when the gain started....do you know babies 2 week or 1 month weight?

    One thing to consider is if there is more going on than only fast letdown. An IBCLC may be able to help rule out issues like tongue tie that make it harder for baby to handle milk flow but, conversely, cause real problems with weight gain once milk production calms down.

    so I will have to pump part of the time. I currently pump ~ once per day, and get 4 oz per breast in 4-5 min
    Do you have enough milk saved up right now so that you can stop pumping or pump much less (less often AND less each time) until you start work? Pumping during separations once you are back at work will of course be needed and for your own comfort and health you may need to pump slightly more often than some other moms at this stage. Of course if you need to pump or risk engorgement at this point, pump, (or hand express) but as little as needed to be more comfortable.
    Am I risking something bad if I delay going dairy/soy-free and it turns out that's the case?
    most likely no, not with a baby who is showing no ill effects.
    Is there any way to confirm if it's a letdown issue instead? Any advice is appreciated. Thanks
    If calming down letdown with the suggestions above helps, then it was a letdown issue.

    Conversely, if you eliminate dairy and soy from your diet for a week or two and there is no improvement, that rules that out. (I am not suggesting you do this.) However, if you do do an elimination diet, and there IS improvement, test the theory by eating a large helping of first dairy, and then a few days later soy, and see if either cause symptoms to return. Still not absolute confirmation, but as close as you are likely to get.

    You could also choose to take first dairy out of your diet and see what happens. It is not always both, and dairy is more common allergen. If no improvement, then you can add dairy back in and eliminate soy. Again, not suggesting this. I think ffld goes a long way to explaining everything.

    Help with fast flow: http://www.nancymohrbacher.com/

    block nursing dos and dont's http://www.nancymohrbacher.com/blog/tag/block-feeding

  3. #3
    Join Date
    Mar 2014
    Central FL

    Default Re: Help: Clarifying Forceful Letdown / Oversupply versus MS

    I agree with PP.
    4 lb in at 7 weeks old is not extremely fast (fast side of normal but not outrageous.)
    Since you are going back to work soon I don't think you want to get too overboard trying to reduce production too much.

    As noted you want to keep pumping minimal until you go back to work. If you really need to keep pumping some to save up for the initial day back plus a little extra, try to only pump a few ounces at a time and then stop or maybe only pump every few days instead of every day. You only really need 1.5 oz per hour of separation for the first day and then maybe a little extra in the freezer just in case.

    If the only symptoms baby is having are occasionally odd poops and a bit of gas and spit up, well for a 7 week old gas and spit up are normal as long as it isn't causing baby too much distress and odd poop on it's own is just something to watch or use to help diagnose with other symptoms.

    As for the gulping and pulling off coughing. Make sure to check that baby doesn't have a tongue/lip tie issue (if nursing doesn't hurt and baby is gaining well it probably isn't a problem, especially if you do have a very strong let down.) If you are really spraying when you let down, you might simply unlatch baby during the strong spray and let that flow into a towel before relatching when it settles down, that way baby doesn't get the fire hose.

    If letting the forceful spray into a towel doesn't help then maybe look at elimination diets but as you noted, you don't really think there is anything wrong and your instincts are probably right.

  4. #4
    Join Date
    May 2006

    Default Re: Help: Clarifying Forceful Letdown / Oversupply versus MS

    with the PPs. This doesn't sound like an allergy/sensitivity issue to me. And even if it is an allergy/sensitivity issue, to my knowledge there is no evidence of longterm benefit from dietary eliminations when done for a generally healthy baby, and there is at least a theoretical disadvantage in avoiding troublesome substances at a time when mom's milk can help coach the baby's gut to recognize the difference between harmful and innocuous.

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