Tuesday, November 15, 2011

Overactive letdown/Oversupply

Last week, I was certain I had discovered the source of GI's evening and morning fussiness. It was dairy! And caffeine! And chocolate! And maybe soy?

Except he would be better for a day or two, then fussy. Then okay. Then fussy. Perhaps there was something else going on, either in addition to or instead of food sensitivities?

It occurred to me to look up on Kellymom about overactive letdown and oversupply. GI tends to prefer to nurse on the left side. When I nurse him on the right, he pops off constantly, and whenever he comes away from the nipple, the milk continues to spray out without any squeezing or pressure. I could see how the constant dribble would annoy him, and that he would pop off so he could catch his breath! The left side doesn't do that. Only the right. According to Kellymom (Kelly Bonyata, who runs the site, is a respected IBCLC), overactive letdown (OAL) and oversupply can cause problems such as gassiness and spitting up. I assume this is due to gulping air while swallowing and the abundance of foremilk, which is the thinner, more sugary and watery milk that begins each feed. Too much foremilk can cause gassiness. (Some foremilk is good. Only foremilk can cause problems. You want the baby to get the full spectrum of milk at each feeding. If your milk supply is normal, this will happen without any work on your part.)

I also realized that he would often be fussy and gassy in the mornings. I tend to nurse him only on the right side at night, just for convenience. He usually only nurses once or twice in the night (yes, I'm VERY lucky), so it's not a big issue to use only one side. Well, if the right side is the one with the OAL/oversupply, and he's only nursing on that side at night, then it would make sense that by morning he'd be gassy and uncomfortable.

So I did an experiment. On Sunday night, I nursed him only on the left side through the night. My right boob felt like it was going to explode in the morning, so I expressed some milk in the shower just until it wasn't sore anymore. The left side was still happily supplying milk, but was quite soft. And the baby? Happy as a clam.

I investigated methods for decreasing supply to make a happier baby. Seems odd to want to decrease supply, but really, you want neither too much nor too little milk. You want the right amount of milk. Basically, I need to tell the right breast that it doesn't need to make so much. The way to do that is not to empty the breast. If I take less milk out of it, it will produce less. Throughout the day yesterday, I'd start him off on that side just to get letdown. I'd make him nurse on that side just until he got frustrated, then switched to the left. I didn't want to not use that side at all, because then I'd become engorged and risked plugged ducts and mastitis. Not a path I wanted to go down. By evening, the right side was noticeably less full. I went ahead and nursed him on that side through the night and woke to a very full left breast! He was a little bit gassy and fussy, but not as bad as he had been. I'm hoping that within the next few days, the supply on the right will settle down, and I can alternate sides normally without a problem.

Then I'll try reintroducing dairy to see if that was really a problem as well! I won't go overboard, as I would expect that too much dairy could be problematic, where just a moderate amount would be okay. Same goes for caffeine, chocolate, and soy. I did have a little tofu the other night and it didn't seem to bother him.

My husband commented, "Imagine if he was on formula" and had these problems. You can't selectively eliminate one ingredient. You have to completely switch formulas and hope. And try different bottles. And maybe you can't solve the problem. On the other hand, you can eat whatever you want. I suppose there are trade-offs however you look at it.

I'm sure I'll be updating on this further, as we try to figure out the age-old question of, "Why is my baby fussy?" Also, he's 10 weeks old, which means he should be growing out of the evening fussiness in the next few weeks anyway, if it's just the "normal" baby fussiness as opposed to being food- or OAL-related. Definitely an interesting ride around here!

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