Question:

My baby seems to be getting a lot of gas from my milk. She`s fussy (cries) at almost every feeding, except in the early morning (approx. 4:30 am). She stays fussy until she falls back to sleep. When my little girl begins to feed from me, she takes a couple of sucks and then begins to cry. I must say she has plenty of wet/dirty diapers and has gained almost two pounds in just three weeks from her birth. This has been tough on Mom, Dad and Baby, and feedings have become very trying. I`ve tried to adjust my diet, but this doesn`t seem to have worked. I admit my diet isn`t very good, but I`m trying to stay away from gassy foods and some dairy products. I did a trial run for 24 hours with Similac lactose-free formula and our little girl seems much more content. I just wish I could provide her with breast milk a little longer. She was born on June 1. Any advice you could give would be greatly appreciated.

If we decide to go with formula, which would be the best? I was given a case of the Similac lactose-free formula, but I read lactose-free formulas are not the greatest for babies. Lactose enhances calcium absorption, helps colonize babies` intestines with favorable bacteria, and is a rich source of galactose – a valuable brain nutrient. Also, some lactose-free formulas substitute with corn syrup, which doesn`t sound good for the baby.

Thank you!

Answer:

Congratulations on your obviously thriving breastfed daughter! I apologize for the delay in responding to your question. I was attending a conference over the holiday weekend. Fortunately, one of the sessions I attended was given by a pediatric gastroenterologist about the very subject you are dealing with!

Lactose is the main source of carbohydrates in human milk. An enzyme in the baby`s gut, lactase, helps break lactose down into the simpler sugars, galactose and glucose, which the baby`s body can use more easily for energy. As you mentioned, lactose also helps the baby`s intestinal tract absorb calcium and it provides food for the lactobacillus, which helps provide a more acidic environment in the baby`s gut. This promotes the growth of “helpful” bacteria and discourages the growth of many disease-causing bacteria.

Considering the role of lactose in human milk, it isn`t surprising to learn that a true lactose intolerance in infants, in which an infant would be born with a deficiency in the enzyme lactase, is so rare that some experts wonder if it actually exists. Later lactose intolerance is more common in many mammals and in some human ethnic groups after weaning, as intestinal lactase activity slows. Symptoms of this usually don`t occur until a child is 4-5 years old.

A young infant may develop a temporary lactose intolerance if an intestinal infection damages the intestinal villi, the structures that secrete lactase. This is associated with a very sick baby having massive diarrhea and often a weight loss or failure to gain-not fussiness or the loose breastfed stools. (Sometimes persons unfamiliar with breastfed stools initially think a baby has diarrhea.) Similar symptoms sometimes are seen in newborns that have recently been treated with antibiotics. While killing the disease-causing bacteria, the antibiotic also killed some of the good bacteria in the infants` intestinal tracts. Again, diarrhea is associated with this problem. In either situation, full breastfeeding is the best treatment since several factors in human milk will help repair the damaged gut after an infection or help restore the “good” bacteria after antibiotic treatment has ended. In either case this usually takes about one week.

It is unlikely that your baby is experiencing even a temporary lactose intolerance. The behaviors you describe are more often associated with a baby that is getting too much of a good thing! It sounds as if your baby may be having difficulty handling the flow of milk at the time the milk “lets down.” If so, a baby may gulp in air, choke, sputter and push away when the first let-down occurs. (The first let-down tends to be more forceful, so babies are less likely to have difficulty with a second or third let-down during a feeding.) Also, using both breasts at each feeding, especially if based on the clock (a number of minutes at the first breast) and not on a baby choosing when to detach on the first side, may lead to colicky behavior and more watery stools.

Your baby will learn to handle the let-down as she matures, but here are some suggestions for coping with the “good” problem of overabundance until then. 1. Offer only one breast for a feeding, but let the baby continue breastfeeding until the baby chooses to self-detach-usually within 10-40 minutes. If your baby would like to eat again in less than an hour or two, offer the breast she already fed from. Occasionally, a baby in this situation does better sucking on a pacifier or a parent`s clean, short-nailed finger. (If your other breast becomes too full or uncomfortable, express only enough milk to decrease the pressure and make you feel comfortable.) 2. Stop the feeding briefly if your baby is having difficulty coping with a forceful let-down. Start again when milk slows from a spray or rapid drip to a slow drip. (Have a towel or diaper handy to absorb the milk.) 3. Try feeding her in a position that lessens the force of the let-down. If you lie down or lean back in a recliner chair and place the baby on top so you are belly-to-belly, the milk will have to travel “uphill.” Often this decreases the force of the let-down, making it easier for the baby to handle.

If using these ideas consistently, a mother usually will see improvement within about a week. Then you can reintroduce “regular” feeding positions to see if she`s ready now for “downhill” let-downs. If your baby still has difficulty with let-down at this point, take her off the breast briefly and see if you can slow the milk flow by pressing the palm of your hand against the nipple tip. (You can do this through clothing when out and about.) You also are smart to look at your diet and ask whether something is bothering her. But as you do this, consider that women in various cultures breastfeed while eating all kinds of foods. No matter what you eat, the properties in your milk vary little; eating a good diet is mainly for your health.

Occasionally, a baby is sensitive to some substance–usually a foreign protein–that gets into a mother`s milk. Such sensitivities occur more often if one or both parents (or their siblings) are highly allergic. If so, the dairy products you eat and drink are the most common offenders. (Soy, egg white, peanuts and fish are next in line.) Most infant formulas are dairy and soy based, so your milk still is best even if your baby is sensitive to something. Also, look at any medications you are taking, your caffeine ingestion, etc.

If you are not seeing change a week after trying the ideas for dealing with forceful let-down and there is a strong family history for allergies, speak with your baby`s pediatric care provider. Consider eliminating ALL dairy products from your diet for a two-week period and see if her behavior improves within 10 days. Don`t eliminate all possible offenders at once, because you`ll have no way of knowing which is causing the problem. You also may find it helpful to contact a breastfeeding support group leader in your area to have someone to talk to and brainstorm with.

References: Riordan, J & Auerbach, K (1999). Breastfeeding and human lactation (2nd ed.). Boston: Jones and Bartlett.

Vonlanthen, M (1999, July). Lactose intolerance, diarrhea and allergy in the breastfed baby. Presented at the La Leche League 16th international conference, Orlando, FL.

All the best for you and your new baby.

For more information:

Go to the Breast Feeding health topic.