Does this sound like oversupply and/or foremilk/hindmilk imbalance and what to do?

[LM96]

My son was born at 30w6d in mid-Nov (his due date was Jan 23).  I have been pumping for him and my supply is great.  He came home about 1.5 weeks ago and we are working on transitioning to the breast.  I am currently doing about 50/50 breast and bottle feedings right now and he seems to be doing well with breastfeeding--good latch and he stays on for about 15-30 min.  We have a weight check later this week and as long as he is gaining appropriately, we will switch to completely breastfeeding.

Unfortunately, a few days ago he started getting a bit fussier, I started noticing signs of reflux (arching back while crying, spitting up a bit more, I could hear the reflux some times), he hates laying flat on his back now, and his stool has turned from a normal yellow to a bright green.  While in the NICU on EBM, he showed none of these symptoms.

When he takes a bottle, he usually takes between 40-60mL (60mL is 2oz).  When I pump, I often get more than that (3-4oz depending on which side).  I'm wondering if he is getting too much foremilk.  Any suggestions about decreasing supply a bit while also continuing to pump?  I'm only pumping 3-4 times per day right now (including first thing in the morning).  My thought is to only pump 2oz per side--does this sound reasonable?  With my other 2 kids, I did end up block-feeding from one side for 4 hours, but I can't really do that while pumping also.

[sahmmie]

Reflux doesn't always start at birth. For my full term babies it started around 6 weeks but didn't get bad enough that I knew something was wrong until about week 10. 

The fact that you hear him refluxing, he hates being on his back, and the arching/crying/spitting does point to possible reflux. 

I'm not sure the green stool is a problem. All of my babies had green stool after the first few weeks. I was told that was normal.

Sometimes reflux is caused by or exacerbated by food intolerances, the most likely of which would be milk, soy, wheat and corn. So you may have to watch your diet to see if eliminating some of these items helps.

Here's a great website that helped me tremendously with my reflux babies.

www.infantreflux.org

Good luck. I hope you find ways to decrease his discomfort very soon.

[PatioGardener]

nak with a squirmy babe so unable to respond fully.how about giving the final 60 mL you pump, rather than a mix?  also you could pump off an ounce or two before nursing (timing hard, i know) to see if that helps.  i would be reluctant to suggest decreasing supply until baby is fully on the breast and gaining well. pumping can be so difficult.  

[carrierwright]

LM96 it really sounds like you have a great grasp of what's going on. While reflux is a possibility but there is a strong likelihood that this is an overupply/foremilk issue. Green stool, arching, fussiness, and spitting up are all indicators. Additionally he may have explosive stools and gag or choke at the breast. It sounds like you've dealt w/this before so you know you're prone to a recurrence. Reducing the amt that you're pumping to 2 oz sounds perfectly reasonable as a starting point. You would also be gauging how your body feels w/that reduction (full is fine, but uncomfortable/painful means express a little more so as to avoid any possiblity of infection) This would really be only a slight reduction, would keep baby at the breast while your supply downregulates just a bit and then after a week or two you could gauge whether you need to reduce more. Remember too that the intestinal upset caused by too much foremilk can sometimes take awhile to fully heal, so just stick with it. How wonderful that you've kept up your supply and have a baby who is almost entirely back at breast!

[myk]

just an idea.. if you can pump 3-4 oz but he generally only eats 2.. why not pump half an ounce, dump it, and then empty the breast (direct feeding or pumping)? that would probably get rid of some of the foremilk imbalance issue, and allow him to be at the breast directly for the good creamy hindmilk and/or have a more balanced bottle of EBM.

[KoalaMommy]

I would suspect a milk allergy before a fore/hind milk imbalance.  Yes those symptoms could indicate an imbalance, but that would have been exacerbated while you were exclusively pumping.  You could always try pumping some off before you nurse to see if it made a difference.

Meanwhile the reflux symptoms with green poo are very common with milk allergy, and my son didn't develop those symptoms till after he was a month.  It takes fully a month to get the dairy out of baby's system: 2 weeks to get it out of yours if you are very careful, and 2 weeks to get it out of his.  I'd go off all dairy (and read labels and not eat anything with dairy in it) for at least a month, and if that doesn't do it, also eliminate wheat and then eggs before adding dairy back in.