Can't fix fore/hindmilk issues - getting desperate!!!

[zazenist]

Hi mamas:

I've shopped this around on several forums, gotten advice from La Leche folks and IBCLCs and am getting NOWHERE.

DD, almost 5 weeks, started having green poops and horrid gas about a week ago... My unfussy, placid, happy baby (who has been BFing like a champ from the get-go) turned into a screaming wreck almost overnight! Now she cried inconsolably for HOURS and HOURS, writhes in what appears to be discomfort, and has very noisy poops and a lot of burping/gas. LLL and IBCLCs diagnosed as foremilk/hindmilk imbalance, and I've been block feeding for about 5 days and seeing no improvement. Her stools still look like pesto and she still seems very gassy and uncomfortable. I've been steadily increasing the length of the block - I'm up to about 6 hours now, but everyone I've talked to seems to think this should have worked by now. Nope - still green poops and screaming. Maybe it's a food intolerance? I was advised that dairy is probably not an issue since I don't drink milk - advisors I've spoken with said that women who just eat some occasional cheese and yogurt (like me) usually don't have a problem. I'm a vegetarian, and looking at a lot of the elimination lists I don't know what on earth I'd eat if I cut out all the stuff you're supposed to! I do have a lot of things going on that seem consistent with oversupply issues.

Other things I've tried without success:
-pumping off a little bit of foremilk each time I switch breasts
-pacifiers (DD seems to do an awful lot of comfort nursing, which I was told might be making things worse)
-bicycling and other leg workouts
-frequent burping while feeding
-side lying/upright nursing positions
-gripe water
-swaddling, walking, swinging, and other standby "fuss fixers"

We co-sleep and I nurse on demand...

Any suggestions? The emotional stress of seeing my babe suffer like this is REALLY getting to me - I'm in tears much of the time, and I'm starting to question if I'm going to be able to keep breastfeeding if that is what's making her sick.

Thanks in advance for any help.

[cascadesmama]

i'm sorry, i don't have any advice for you but i can offer i'm veggie with just occasional cheese in my diet too (no milk, haven't eaten yogurt in months...) and dd has pesto poops too. we block nurse as well. she seems a little gassy but not too bad and she doesn't ever seem uncomfortable with it. she did wake up screaming about 30 minutes after we had finished bfing tonight but i think it's teething pain not intestinal pain. but i'll definitely be keeping an eye on this thread to see what suggestions the other mamas have for you good luck and i hope you and your little one find some relief soon.

[gamelia]

It's pretty "normal" to see a change/increase in fussiness at this age. I agree that there may be some fore/hind milk issue here, but I'm a little confused by some of your OP.

You mentioned that you're pumping off a little foremilk before switching breasts... Do you mean switching breasts every 6 hours or are you switching during feedings? How much are you pumping off? If you're just on one breast for several hours, are you pumping off before each feeding? I'm concerned that regular, continued pumping off may be contributing to the oversupply issues, not helping.

How are your nipples holding up? I wonder if you're having forceful let-down issues. Are they white or creased after feeding? She may just be taking in a LOT of air while trying to regulate milk intake. This will absolutely cause extra gas and discomfort as well as loud, farty poops.

After feedings, how long are you keeping DD upright? 30min+ after feedings may help if she's having GERD issues.

Are you trying colic hold after feedings (baby stomach down on your forearm, head supported - you can pat or rub her back)? Supervised tummy time on firm surface may be helpful as well.

If you know you're having oversupply issues, you might start drinking sage tea, peppermint (I prefer 3-5 drops of essential oil in 8oz of water, but tea works as well), compresses for swelling. (Frozen peas work wonders.)

Also, I know it can be hard to eliminate things from the diet - especially when you're veg already - but Aspirin, citrus, tomatoes, beans and gelatins should be avoided.

Try to stay calm and proud of yourself for working so hard for your baby. Keep us posted.

[zazenist]

Hi cascadesmama and gamelia - thanks for taking the time to write! Gamelia, since you asked some specific questions, I will try and answer them...

I'm pumping off about an ounce of foremilk at the start of each block of feeding, so I will pump the left breast and then feed off it for the next 6 hours, then pump the right breast and feed off it for the next 6 hours. Make sense? I'm only pumping at the start of the block, NOT before each individual feeding within that block.

My nipples are fine - not sore, white, creased. I'm not sure if I'm having OALD issues - sometimes DD seems to gasp and gulp while feeding, other times not. I've tried hand expressing a bit when I get a let-down with individual feedings but no consistent results from that.

I keep her upright for ~10-15 minutes after a feeding while I try and burp her thoroughly... have also been putting her on her tummy - one of the only things that seems to have ANY hope of calming her is to recline with her chest to chest and rub her back.

The only thing off the list of foods you mentioned that I eat a lot of is beans... I don't take Aspirin at all, and I don't eat a large amount of citrus or tomatoes - maybe only a couple servings a week... I have a bladder condition that is irritated by the acid in those foods, so I eat them sparingly. Gelatin would be a rare thing in my diet, I'd think. I don't eat a lot of prepared foods, so I know what I'm eating for the most part.

What else might it help to mention?... Gee, I don't know... I'm so sleep deprived I can barely think straight... Feel free to ask any other questions... Thanks again for taking an interest!

[Blessed_Mom]

Try and eliminate all dairy and soy (even hidden forms) from your diet for 2 weeks and see what happens. They say it takes 4 weeks (2 weeks to get it out of your system, and another two from babys') but try and watch for atleast 2 weeks.

If you see no improvement you can eliminate corn and gluten too ...OR try the elimination diet for 2 weeks and see. Good luck!

[bean-e]

Hello mama,

I am sorry to hear that you and your baby are having such a difficult time. My baby and I experienced a similar situation and I too thought it was a foremilk/hindmilk imbalance. I tried all sorts of way to lower my milk supply and her poop was still green. Things started to improve when I went off of dairy (hidden dairy as well), eggs, gluten, and soy (this caused acid reflux for her). It's only been about two weeks and the soy discovery was much more recent, so it's hard to say how much improvement we have seen. She seems to be sleeping better and her eczema has definitely improved...so those things keep me going. Changing your diet might be helpful for her, and what about your emotional state? Is it just related to this issue? I am concerned that you said you are in tears most of the time. How are you taking care of yourself?

[zazenist]

Thanks again for all the replies... Bean-e, I'm doing fine - it's just hard to see my beloved LO suffering and that's been wearing on me, but otherwise I'm hanging in there OK. My sadness is just around this issue and feeling so powerless to help my LO.

Just after I made the OP, we seemed to steer into a calmer 2 days - very little crying and DD seemed "herself" again - smiling, cooing, sleeping normally, etc. I thought we were out of the woods, but then today the crying came back as bad as ever. She has cried and screamed for a total of about 12 hours today. What's weird, though, is that for the past 24 hours or so, her poops are back to being pretty yellowish, but she still seems very gassy and her stools are explosive.

I started a dairy elimination yesterday as well as keeping a food diary, but here's what I don't understand... If milk proteins are what she's reacting to, say, and they are persistent enough in my system that it can take up to 3 weeks for them to go away, then why is the fussiness (if caused by dairy) not a constant problem? How can she have significant periods, even a couple days, where she doesn't fuss at all if my diet is basically unchanged? I haven't had a lot of variety in my diet since she was born - been eating pretty healthily, but same things over and over since they are easy and quick to fix. With a diet that's pretty consistent, it just seems weird that DD's issues seem to come and go. Makes no sense that I can eat the exact same thing on two days, and on one she's fine and another she cries inconsolably.

Here's what I've been eating over the last week since the crying started:

-homemade vegetable soup and lasagna
-fresh fruits and yogurt with granola
-graham crackers with either peanut butter or almond butter
-a couple homemade brownies
-raw carrots, spinach leaves, cherry tomatoes, feta cheese
-some vinaigrette dressing

I had one grilled cheese sandwich, a little bit of popcorn, some rice noodles with steamed broccoli, and half of a dairy-free burrito (beans, rice, veggies, guacamole) from Chipotle.

Any ideas? I know it could be anything in my diet, from nuts to corn to wheat to soy... I'm just puzzled by the inconsistency.

Also: We had her at the pediatrician yesterday to rule out any other causes for the fussiness, and the ped said green poops were normal, though that's not the impression I've gotten from all the breastfeeding lit I've read, which seems to say green stool is indicative of a digestive problem. Huh?

[witchygrrl]

Have you tried any gripe water with her? When my DD was little, it relieved her of her gas (and hiccups). Soy also does seem to be a huge culprit for food sensitivities, but it doesn't look like you have been eating much of that.

Oh, peds don't tend to know much about breastfeeding issues. And starting at 4 weeks, probably is also having a growth spurt, hence wantng to eat more.

mama.

[hippiemama76]

Per our doctor's advice, we used probiotics with DD2. She was starting to get a little colicky and within 3 days of starting the probiotics she completely calm and comfortable.

[odoole]

Zazenist -- I just responded to your CD question, but then I saw this post as well. Just wanted to let you know that DS and I went through the exact same thing -- pretty much everything you described. It took a while for the problems to show up with him as well, but around 4-5 weeks, he started to show signs of being very uncomfortable, with the antsyness, arching back, grunting, etc. Same as you, the only thing I could really do was lay him on my chest and pat his back for hours at a time. Fortunately, he wasn't a screamer, but I think that was just because he was premature and didn't have the energy to be one. It was very obvious that he was uncomfortable though, and I agree it's totally heartbreaking to see your child like that.

You're doing all the right things. The foremilk/hindmilk thing was an issue for me as well, and over time your milk production will regulate itself a little better. Cluster feedings are the way to go until then. I agree that may be causing some of the greenish poops, but that's probably not what's making your daughter so uncomfortable. I would keep going with the total dairy elimination and see how it goes. I'm also a vegetarian, so I know how tough it is, but ultimately if it makes your daughter feel better, it'll be worth it.

With my DS, I saw some results about a week after I eliminated dairy, and then we had a couple days setback, at which point I realized that soy was a problem as well. I think those two go hand in hand quite often.

So now he's almost 4 months and things are SOOOO much better. Actually, I'd say they markedly got better really about two weeks after I changed my diet, but by now they're practically non-issues. I do notice every once in a while if I eat dairy or soy -- either by accident or as a test -- he does get a bit uncomfortable, we have a sleepless night and the green poops show up again. Fortunately he still doesn't scream too much.

But note that some of the improvement just has to do with maturity. As your baby gets older, she'll be able to deal with the gassiness better, so even if you still have an oversupply, it won't bother her as much. Same goes for the protein intolerance.

Are you giving her the vitamins that the pediatrician prescribes (Tri-Vi-Sol)? I noticed that made him feel miserable as well, so we stopped using those. We occasionally do Baby D drops instead. Also, are you taking DHA supplements? I noticed we had bad days when I took the fish-based ones compared to the non fish-based ones. Could have been a total coincidence, but it happened frequently enough that I threw away my pack of fish-based supplements. (Oddly enough, there was cod oil in the multivitamins as well. Tossed those out too. Maybe it was just me being superstitious though.)

Also -- how is she sleeping? For us, sleeping at an angle was critical. We tried various means of doing that along the way -- from angling the crib, to angling the snugglenest, to using an Amby. (The amby was miraculous, but unfortunately not very safe.) For naps he sleeps on his stomach on my chest or in the sling. Lately we haven't had to angle quite as much, but we still put him to sleep on his side.

By the way, I didn't have any luck with gripe water at all. I never tried probiotics.

Good luck. Just know that you're doing all the right things and that your daughter is at the age when things are going to be the worst. Whether or not you fully identify what the problem might be, I really believe things will only improve from this point.

[grumpybear]

Went through something similar with DD (now 9wks).
I noticed that block feedings of 6hr intervals was not working so on gut instinct, I actually shortened it to 3-4blocks. On top of that, there was also the gasping and choking so I suspected OALD/oversupply. Whatever it was, it seemed that the flow of my milk was a bit too fast for her. At the start of the nursing session, I'd nurse while I was laying down and she on top of me. That way, milk was flowing against gravity, KWIM? After I felt my letdown, then I'd start nursing a bit more upright.

[Bokonon]

I agree that it sounds like it could be a dairy protein sensitivity. I think that it's possible that your baby just gets more comfortable at times, thus less fussiness, and maybe it's during a time when there are fewer proteins bothering her tummy? It's hard to say, but it definitely sounds to me like a total dairy elimination for at least 2 weeks is worth a try.

[zazenist]

Checking back in... Well, I did a dairy elim for 2.5 weeks, and no change. I quit that and a few days later the poops magically went back to yellow and have stayed that way ever since. I did cut my blocks back down to about 3 hours, but I'm not being very precise or strict about it so sometimes it's longer or maybe even shorter. I'm also having to offer both breasts at a feeding at times since LO is growing and seems not to be able to get full on one. Also, the fussing/inconsolable crying has stopped as well and she seems way less gassy despite us not really doing anything differently on any consistent basis (since nothing seemed to help).

So sounds like it's not what I'm eating... maybe just an issue of her digestive system needing to mature a bit? I'm not complaining, mind you... Happy babies are !!!