BF questions for a friend

[Tweakster]

My BFF just had a little girl on Nov 13.  She started BFing and it was going well but now the length of time her LO feeds is dropping.  It used to be close to 30 mins and now it's like 15 mins and then she falls asleep.  She also noticed that there's a lot of milk pooling around LO mouth when she's feeding.  And also baby gets wicked hiccups and milk comes out her nose.  Is this normal?  I'm petrified that it's a sign of reflux...she knows what we went through and she's scared too.  I am paranoid though and told her as much lol

She has a health nurse coming over on Monday but she said that LO is really fussy at night and not taking much to eat at all.  If she does start to eat she falls asleep and she can't really keep her awake.  But then as soon as she puts her down, she wakes again.

[teilvnav]

Hiccups can be normal, as can the milk coming out the nose. It can just be part of the transition to the LO learning how to nurse and swallow milk. She could be waking as soon as she is put down because she is still hungry, because she didn't take a full nurse. Before thinking about reflux (which is of course a possibility), I would check these things:

- does the LO have a good latch? Your friend should be able to see the jaw moving as LO swallows and not feel pain (although a bit of pain in the early BFing days aren't abnormal especially with the first child)
- can she stay awake longer to take more? I would try burping her and putting her back on the BB, stripping her down to her diaper so she isn't as warm and comfy, and stroking her face/hair/back to keep her awake
- does feeding in other positions help? Get her to try feeding lying down in the bed (side lying) or the football hold and see if that helps the feed go better

She could just be a sleepy baby; Anna had to be woken for feeds and actively kept awake to nurse for the first month. It is normal for an LO to take less time to nurse as they grow, but not usually that much at only a week old. Her DD could also be struggling if your friend has a strong let down, which would be exhausting for such a young tyke. If that is the case, the football hold could really help because the baby is sucking the milk out at a more upright level. The fussy evenings can also be a normal part of just adapting to life on the outside. If none of those things help though, I would start to look at whether it could be reflux.

[Tweakster]

Thanks Amy.  Ok so hopefully the health nurse will also go over this with her.  She may have a forceful let down, in the beginning when it was just colostrum she was hungry a lot more and ate for longer if that makes sense.  She was fussy the first night they brought her home and they ended up giving her formula because her milk hadn't come in and she was just getting angry at the breast.  Then the milk went kapow and LO was happy again.  But in the last few days she said she's been fussy, and angry and freaking out when it's time to eat.  I would think that's normal lol??  Then she's not feeding for long and falling asleep.  Could be a GS??  It seems to be equally bad at night and in the day.

She had some pain but it seems to be going better.  They told her in the hospital that baby had a good latch. 

I didn't know about the milk out of the nose being normal...how unpleasant lol

[Shiv52]

There is a GS at about 7-10 days. I would just tell your friend at this stage to feed, feed, feed.  Its all establishing her supply.  Also tell her to wary of supplementing this early as not only can it effect supply but at our BFIng workshop with Rosa they were explaining how the amount of milk consumed of formula and BM vs the amount of calories is really different and the formula can stretch the tummy much more than it would with just BFing and make the baby less satisfied with the BM. 

I also wondered about the overactive letdown.  If her milk is flowing really quickly it can help to get a letdown first and let the milk flow a bit and then latch the baby on. 

HTH xx

[C&B&E]

I've got a refluxer and a forceful letdown (so know it could be either of those things iyswim) - but I also found that when Ev was fussy and angry feeding it was sometimes because she was OT - it took me ages to figure this out  ...and then of course she would fall asleep while feeding as it helped to calm her down.  So I just wanted to throw that into the mix as well  !!  I think it is such early days that it will probably become clearer over the next couple of weeks.  For what it's worth - I was told that DS had a good latch in hospital...fast forward a week and he had lost weight as he had a tongue tie and it became clear that could not feed properly  (he was basically only surviving because of my forceful letdown)...so if she's still having problems it might also be worth asking for a second opinion on her latch.  Oh, is the baby having plenty of wet and dirty nappies?

x

[becj86]

Lying back in a recliner helped DS with my forceful letdown, as did baby-led attachment. I latch, then lean back so the milk is flowing against gravity. I had 5-6LCs all say the latch was great in hospital (I was a bit of a curiosity and everyone wanted to visit me) but DS still took a chunk off my right nipple through a nipple shield when he was ~1week old.

He had hiccups something chronic, and as my milk supply continued to increase with all the feeding (because he was cranky with gas and foremilk overload) it all got worse and worse. I found I was feeding when DS was tired as well as when he was hungry because I didn't know his cues very well.

Its important if she has an oversupply and an overactive letdown that she feeds on one side til its completely drained. That might mean feeding only on one side and starting that side again for the next feed but if the breasts are always partly drained the supply keeps increasing with the suckling and not having a full breast to release hormones to say "Stop! that's enough milk for now.".

[Tweakster]

Thank you all!  She had a visit from the home visitor who told her that everything looks good.  She does have a fast letdown and they gave her the tips about gravity and laying back etc.  She is expressing milk now so that her DH can participate - he really wanted to and she also gets her bulk of sleep in that first part of the night.  Baby has no issue going between bottle and breast it seems.  She is still eating regularly and her weight has gone: 7 lb 1 when born, 7 lb after leaving hospital, 7 lb 3 at 3 day appt. now at 3 weeks old she's 8 lb 8 oz.  And she isn't hiccuping as much and the milk out the nose still happens but she isn't bothered by it so it's normal I guess.

She is still a really super sleepy baby though and hard to get her to take a long feed despite doing all the things you mention.  She is trying all the tricks - that kid is dead to the world when she sleeps lol

[Shiv52]

Really glad things are going so well for your friend! Tell her to enjoy that sleepy phase!