5 week old, fussing during feed + lots of spit up

[Swannie]

My baby is just about five weeks old and gaining weight very well.  She breastfeeds 8-11 times per day.  Dr. says she may have a  bit of reflux, but not conclusive.

I have a heavy let-down that I thought she had learned to control a bit better but I think we have regressed.  The past few days she has been very fussy at the breast, coming off and on, thrashing and kicking.  Sometimes she briefly gasps and occasionally chokes (horrible to watch). She eventually eats but it is a struggle.  She then spits up a lot after.  While I burp her, while I change her, if I put her in an infant seat/swing and later after I lay her down.  This morning she continued to spit up every time I put her down until two hours after the feed.  The spit up seemed to be fresh milk and at other times curdled milk.  I was eventually able to put her down and she has been sleeping on her own for the past 40 minutes.

She does not appear to be in discomfort after the spitting up.  She gets upset when having a fussy time on the breast, or after gasping, but she seems to recover quite quickly.

I am wondering how much of this is a latching issue (we sometimes struggle to get it right), versus a heavy let-down issue versus a reflux issue.  Or a growth spurt?  Things got worse a few days ago when she seemed to get hungrier.

Any input will be appreciated.  I am tired and stressed out. 

[Fiver]

Welcome!

Have you checked out our FAQ's - Frequently Asked Questions & Related Information - Breast ?

Some that might be of particular interest to you:
Reflux or oversupply/ overactive letdown?
Forceful Let-Down Problems

[*Ali*]

Welcome and hugs. That sounds tough.

This FAQ from the reflux, colic and crying board also has helpful info on optimal positioning and non-medical adjustments Reflux 101 - General reflux information

Did your doctor consider prescribing meds? Sounds like some of her symptoms are pretty severe, way worse than my DS2 and we were prescribed infant gaviscon which helped lots until he outgrew it after a few months.

These threads also have some good ideas tips for calming my refluxing LO and Massage, Colic, and recognising various cries info.

[Shiv52]

The spitting up seems like it could be from getting comfortable to feed initially and seems like she could be swallowing a lot of air. My DD2 struggled with my flow in the early weeks. I found hand expressing a bit first and catching the milk in a cloth before latching really helped. Also using different holds helped too. I used one where you position the baby kind of vertical to your body as opposed to horizontal and that helped a lot.

Have a look here as there are some pictures to show the hold I mean.

Hugs to you. You are doing GREAT. I found 5-6 weeks really tough. It's like the adrenaline has worn off of having a newborn  and the sleep deprivation sets in and I was truly exhausted. But after a couple of weeks it evened out.  I really did as little as possible but BF and snuggle my babies at that age. I also found going to bed after the evening feeding session and leaving DH to sort her for bed and then he'd bring her to me when she was next hungry and I'd do the DF in bed then he'd settle her back to sleep. Sucked going to bed so early but for those for weeks getting extra sleep really helped as I did all the night feeds and NWs after midnight.

Do you have her basket or crib inclined a bit?  That helped enormously too.

[Erin M]

If you think a heavy let down is the problem, I would try to either hand express or pump until the let down and catch it in a bottle or towel and then let her latch on.  That often helps slow the flow until your LO learns to cope with it a little bit better.  Some ladies also have great success with laid back feeding where the baby self-latches and you've got gravity on your side working against the rapid flow of milk -- there's a video on it here: http://www.biologicalnurturing.com/video/bn3clip.html
Also, you can feed slightly reclined in a recliner or leaned back on pillow.  Are you getting good burps out of her after the feedings?  That's not always the easiest thing when they're this tiny.  Has she had a growth spurt lately?  Sometimes after a growth spurt, your flow ramps up again and takes a little to settle down. 

[Shiv52]

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

Sorry here's the link. I have mummy mush brain

[skatty]

My girl was exactly the same, in fact she spat up until she was at least a year, hated lying down on her back or front (was a nightmare for sleep  ) and this could have been caused by my fast letdown but she was also MSPI (milk soya protein intolerant) so i don't know what caused it exactly  I remember reading a tip to take baby of the breast for a moment after let down (yes it can be messy  ) and then reattach. The positive thing is as my dd got older feeding sessions would be done in 5 minutes and so long as I kept my diet soy and dairy free the spitting up didn't use to bother her. Hang in there it will all get better 

[Swannie]

I have major progress to report.  Baby and I spent a few days focusing on correcting this problem.   I think we have figured out what works for us.

After reading this extremely helpful website (https://www.llli.org/faq/oversupply.html) we spent two days doing block feeding.  the first day we did one breast per feed but that didn't seem to fully fix the problem so then we spent another day doing two-feed blocks (one breast, two feeds).  The choking and gasping reduced dramatically and as did the spit up.  I ended up overcompensating a bit because during a couple of feeds my breasts were a little too empty for her and she was not impressed.  So I then gave her both breasts to try to get the supply up just a little bit.  This seemed to work.  She is protesting a bit about having to work a little harder earlier in a feed, since the milk no longer plunges out for a long time.  But usually by the end of the feed she is drowsy, if not fast asleep.  We still need to improve the latch because I think she and I developed a bad habit of shallow latching during all of the garden hose feeds these past few weeks.  She does not open her mouth very wide and when she does get on nicely she sometimes re latches mid-way to a more shallow latch.  If anyone has tips on how we can fix this please let us know!

I do not think she has reflux after all because the spit up is mostly minimal now, unless we have a bad feed.

Some other things that we changed in the past few days:
-we abandoned the breast-feeding rocking chair and the breastfeeding pillow.  Neither allow her to be under the breast enough.
-our best place to feed is on the couch, with me slumped back with terrible posture and her slightly on top of me and on a slight diagonal
-at night we feed in bed and try to replicate the posture we have on the couch but it is not quite as good (still way better than the chair though)
-I hold her upright or slightly reclined for 20 minutes after a feed, although I may be able to reduce or stop this soon because the spit up has decreased a lot.  I am going to be cautious until I know for sure.

I am not going to get smug yet, as we still have some work to do.  But I am feeling more positive.  A few days ago I thought we may have to give up breastfeeding but now I think we can continue.

PS- We tried the side lying hold.  It was peaceful and seemed like an amazing feed all three times we tried it.  However, she spit up a lot all times so we don't do that anymore.  Too bad, because it was handy for the 4am feed.  Anyone have any thoughts on why that led to more spit up?

[Fiver]

That sounds like a great update, well done!

It could be that when you're lying down together to feed that she gets a bit of wind in her tummy (especially if you're having some issues with a shallow latch where they can end up taking in more air - is there any clicking or anything to go with it?) and where she's burping whilst lying down, the milk is being pushed up.  Both DS and DD, to an extent, were the same.  I used to put a muslin under their heads to try to catch any overflow.

[Shiv52]

Don't give up on the lying down feeding. You may find in a week or two she'll get better. Both mine spewed a bit lying down too. I think they were just so cosy and feeding they took in loads of milk then wind made it come up again. Like Amanda a muslin cloth helped!  NFs were so much easier once I got the lying down feeding sorted!!

Well done you on all your progress. I can't believe I forgot to mention block feeding. That helped a tonne here too!

Hope it all keep going so well! Hugs xx

[*Ali*]

Thanks for the update. Good to hear things are improving

If you can get her in a position where she is higher than your breast during the lying down feeding gravity will help you and the spitting up. Maybe lay her on a low pillow? Obviously you need to be safe during the night especially if you are sleepy yourself though.

[Erin M]

Great!

[Swannie]

We have hit another roadblock:

Baby is rejecting the right breast.  At first I thought it was a fluke but it has happened the last four feedings on that side.  Whenever I give her the left she latches on fairly well and drinks until full.  When I give her the right breast she cries, fusses and comes off repeatedly.  I end up having to give her the left breast, which she takes and drinks until full, usually falling asleep and coming off with milk dripping down her little chin. (so cute)

Did I mess up my supply on the right side by doing those block feeds?

How can I fix this?

Is it possible to just feed her from the left and pump from the right for later use, or is this a silly idea?  (we have not yet introduced the bottle because I wanted to get breastfeeding well established and this clearly has not happened yet.) I am getting tired of seeing her so upset.

Help please!!

[Fiver]

Sometimes LOs will be 'tricked' into feeding from a less preferred side by sliding them across from the favoured side (cross cradle hold) to the other side (rugby ball hold) so they're the same way round.

Could there be a logical reason why she might be uncomfortable physically on the right side?

[NoonieP]

Perhaps your right side is more forceful in the letdown and its more uncomfortable for your LO? Maybe she's figured this it and that's why she is rejecting the one side? (Thus making her a smart little baby!)