Mucus poops and transitioning from bottle-to-breast in a preemie

[nemrac917]

BG: D's 6 weeks old, born early at 32 weeks.  He was in the NICU for almost 6 weeks, and just came home Monday, 10/29.  During his time there, I concentrated on pumping/bottle feeding so we could make the docs happy and get him home sooner, where I could then start introducing the breast and feeding on demand.

Current Issue:

D's been having some really mucusy poops and increased gassiness/discomfort the past 1-2 days. Research tells me it's likely a milk-protein sensitivity, which would normally mean cutting out dairy from my diet.

BUT... this only started after we came home and I introduced the breast. Another possible cause could be a foremilk/hindmilk imbalance. Not an actual imbalance, but a situational one since I'm putting him to breast first, then finishing with the bottle. It's possible that he's getting tuckered out before getting the good hindmilk, leading to the 'imbalance'. I try to pump for a bit before putting him to breast, but it's hard to sit there pumping while he's fussing away, just wanting to eat.  No early signs of hunger to alert me it's time to start pumping in preparation for him waking up. He goes from sleeping-fussy/hungry in about 30 seconds flat.

I was thinking maybe I could give him a little in the bottle while I pump some, to take the edge off his hunger and pull the foremilk off my breast, THEN put him to breast? Does that sound like it might work?

Any other ideas?

[Bokonon]

Congratulations on your baby's homecoming!  Is it possible that you have an overactive letdown?  That can often be the cause of mucousy poops as well.  When my 32 weeker was in the NICU, I pumped so much that I had a crazy letdown.  I had to scale back on how much I pumped to get the letdown under control.

[nemrac917]

How can I tell if I have an over active letdown?

[lilzippy59]

I have a similar problem. DS was in the Continuing  Care Nursery for 3 weeks and although he breastfed on demand after birth and the 1st day he was mostly bottlefed my milk in the nursery. I waas able to get up there to nurse once a day on average. We still need the shield due to an overbite leading to him not getting a good seal. I EP'ed for him through 10 weeks old, and I had a major oversupply. I was pumping 50-60oz per day and have 1300oz+ in the freezer.  He has been EBF the past week (will be 11weeks tomorrow) and we've had our fair share of challenges but its well worth it!

You may have an overactive letdown if you have an oversupply, which you can tell by how much you pump. Also if baby gags, chokes,  and/or spits at the very beginning of nursing. Since my supply is still regulating I'm having lots of engorgement and OALD issues. If I'm super engorged or he's gagging after latching I'll spray into a towel or the sink until it slows down, then he nurses without much issue.

Another thing that's helped me is a variation of block feeding. He was getting way too much foremilk in the beginning (went from pooping every 2-3 days to pooping after EVERY feed and a big increase in gassiness). I offer the same breast for 2 feeds in a row and then switch and repeat. This ensures he gets enough fat rich milk and helps reduce my supply. His poops are back to normal.

WWhat  happens  if you don't offer the bottle ?

Good luck!

[rinap]

Has your doctor said the poops are an issue? Sometimes these things resolve on their own as you transition from pumping to nursing. But if he needs a little milk from a bottle to calm down before nursing, that can be fine. He's still not quite ready to be born, so it wouldn't be surprising if he still needs some extra help.

(My girls were born at 36 weeks and it was 2 months before we were breast-only for daytime, 3 months for nighttime, still going strong at 17 months)