Ravina Sewani

If your baby has green, foamy or frothy, explosive stools and pain, it might be a case of lactose overload. Lactose overload can happen when your baby gulps a very large quantity of breastmilk either due to a long gap between the feedings or due to an oversupply of milk. Healthy babies are able to break down the lactose in normal volumes of milk. The presence of fat in the milk ensures the slow movement of milk through the gut. But if your baby consumes a lot of milk that is relatively low in fat, it can rush through the digestive system without being digested. This can cause the problem of gas causing pain and frothy stools. If you suspect lactose overload, try to check your baby's latch. Try different positions to feed your baby if you have a problem of oversupply of milk. Try frequent feeds as your baby to avoid build up of watery low fat milk. If the problem persists, you know what to do, head straight to your doctor.

Lactose overload happens when the milk is not digested properly.

Lactose Overload

Milk production is in abundance during the early days, which is good. But as soon as the baby settles in – in most cases – the flow regulates on its own. Sometimes though, the breastmilk volume may still be high and there may be a very forceful spurt of milk with a forceful let down. This may cause problems for you and your baby. Usually babies develop a breastfeeding pattern within the first month. If after a month, your baby is still restless during the feeding, or pulls off your breast, coughs, chokes, gulps quickly, has painful cries, holds on to your nipple with a bite like hold, oversupply might be the issue here. You, on the other hand, might experience engorgement, have bouts of mastitis, or you may feel a strong let-down, and leaking breasts. Due to oversupply, a condition called Milk Ejection Reflex occurs in which the milk is released from the milk ducts in a forceful and in an almost explosive manner. Oversupply could be either due to your body making more milk, or when you don’t empty your one breast fully before offering the other, or thyroid. You can handle this situation by trying a reclined position while you breastfeed, you can try using nursing pads, and express little milk before feeding. You can use breast pumps and store the milk. Just be careful that your child does not choke while breastfeeding. If none of the methods work, you should consult your lactation consultant.

It is possible to have an oversupply of milk.

Oversupply of breastmilk

Palak Vyas

Feed both of your babies at the same time, it will save your time too. However, babies are individuals, so one twin may want to nurse every three hours, and the other, every two hours. Tips to feed twins at the same time:<ul><li>Consider a nursing pillow: There is a specially designed pillow available in the market for nursing twins at the same time. You can also use two regular pillows or rolled-up towels.</li><li>Find the right nursing position. Try positioning both babies in the football hold (along your side) or the cradle hold (across your chest), using the pillow to support their heads. Or combine the cradle hold and the football hold, again using the pillow for support. You can use trial and error method until both you and your babies are comfortable.</li><li>Alternate breasts:&nbsp;Switch breasts for each baby at each feeding to stimulate both breasts equally. Keep alternating breasts with babies, so the babies get equal eye exercises and stimulation. By practising this method, equal amounts of milk is produced in both breasts.</li><li>Focus on your latch. With twin babies, there are much more chances of sore nipples due to continuous nursing. Soreness is usually caused by a poor latch. So if your nipples are extra tender, try a prescribed cream to ease the pain and spend extra time working on your latch with each baby.</li></ul>

For the first few weeks, infants need to breastfeed eight to 12 times per day. That is once every two to three hours, day and night.

Breastfeeding twin babies

<ul><li class="ql-align-justify">Breastfeed your baby as much as (s)he wants. In the early days and weeks, your baby will wake and feed frequently, day and night.</li><li class="ql-align-justify">When your baby is a newborn, their stomachs are tiny. Babies can physically take only small amounts of milk. They can digest breast milk easily and it soon gets absorbed it into their system. That's why babies might demand constant feeding.</li><li class="ql-align-justify">After the first few days, most young babies feed at least 8 to 10 times in 24 hours. This means your baby could be asking for a feed every 90 minutes to two hours.</li><li class="ql-align-justify">It's worth keeping an eye on the number of feeds the child has, and offering them your breast, even if the baby not asking. By breastfeeding often, you're building up your milk supply. The more your baby feeds, the more milk you will produce. This is called responsive feeding. And your baby will love snuggling into you, whether or not they are hungry.</li><li class="ql-align-justify">Do check that your baby is latched on well. Otherwise, (s)he may be nipple-feeding, rather than breastfeeding. This can make your nipples sore, and your baby may be unsettled, because they can't get a good amount of milk. Get advice from your elders or paediatrician if you're worried that your baby isn't feeding well.</li><li class="ql-align-justify">Your baby needs to open wide and take a good mouthful of your breast. Once they have latched on, the chin should be touching your breast, the nose should be clear and baby's lower lip should be evened.</li><li class="ql-align-justify">Your baby may want to feed more often, or for longer, at night. This is normal, because your body produces more prolactin, the hormone that makes milk, at night. By feeding often at night, your baby stimulates your body to make more milk.</li><li class="ql-align-justify">Over the next few months, your baby's feeding pattern may become more predictable. This can take a while to establish, though, so try not to be disheartened.</li><li class="ql-align-justify">Always keep the weight of the baby in check, to track their physical development. The track of baby’s weight will also help you to understand whether your baby is feeding enough or not.</li><li class="ql-align-justify">It is recommended to JUST breastfeed your baby until the age of twelve months and it can be continued till the age of four depending on mother's and child's comfort.</li></ul>Signs that your child is adequately breastfeeding:<ol><li class="ql-align-justify">Frequent urination up to 6-7 times a day.</li><li class="ql-align-justify">Adequate weight gain.</li><li class="ql-align-justify">A sleepy baby post breastfeeding.</li><li class="ql-align-justify">Let down reflex (Milk comes out from the other breast while baby feeds from one breast).</li></ol>

Worried about whether you are feeding the child enough? Look for the signs that your child gives.

Breastfeeding Schedule

Samiksha Choithani

Babies sometimes have their favourite side, and only prefer to take feed from one breast. At times it is because that particular side produces more milk or sometimes it is the side that produces less. The baby might avoid the most productive side as (s)he may not want the milk to gush out quickly that forces them to gulp fast.<ul><li>You can try offering one breast first, and then the second. Pump on the side that is not preferred by the baby as the baby might get frustrated if you forcefully offer both sides.</li><li>Keep a track of urine, stool and weight of the baby, if that is on track, let the baby feed on his/her preferred side and you can pump the other side.</li><li>If the baby isn’t gaining weight, try to feed the pumped milk from the other breast or try new positions to make the baby feel comfortable on both sides.</li><li>If the problem is with nipples, the baby may prefer to latch the one that is fully engorged. Try to talk to your gynaec, they will help you to pull the nipple on the other side (it is little painful) but once done, baby and mommy will be comfortable throughout the breastfeeding journey.</li></ul>

Many babies have a favourite side to feed on. However, if you are experiencing a problem with that, the situation can always be improved.

When baby prefers one breast!

The first yellow milk (fluid) produced in the breasts is called colostrum. It is the first stage of breast milk production. Colostrum is thicker than your usual breast milk. Colostrum/yellow milk lasts until the transitional phase or mature milk is produced i.e. till the second or fifth day after the birth. Colostrum is like a child’s first immunisation, it is full of antibodies, white blood cells and other immune properties. Benefits of Colostrum for the baby are:Builds a strong immune system.Creates a tough layer on baby’s stomach and intestines to fight with germs that cause illness.It serves as a laxative that helps your baby pass the first dark stool/poop.Prevents jaundice.It is a perfect blend of nutrients to make the child’s brain, eyes and heart strong.Prevents low blood sugar in newborns. A baby should take 1-4 tablespoons of colostrum per day. Note: Do not give honey or any other food substance during birth, the first yellow milk is a great source of nutrition.

Colostrum has multiple benefits for a baby's health and should be the first food give to a baby after birth.

Colostrum and its benefits for Babies

When moms start feeding the newborns, the nipple often turns red and pointy instead of round and smooth. This could be due to the problem in latching technique, insert your finger into the corner of your baby's mouth to stop feeding for a while when you feel pain -- and then try latching on again. Ideally, your baby should take at least one inch of your areola (entire circle surrounding the nipple) into the mouth. Measures to treat sore nipples:<ul><li class="ql-align-justify">When you take bath, clean the area with water and do not apply any soap. Your areola secretes oil that keeps your nipples moist. If you use soaps, these protective oils might be removed.&nbsp;Air-dry your nipples and do not rub them harsh. There is no need to clean your breasts before breastfeeding, offer your breasts as such. The microbes on your breast surface will help in the development of your baby's gut bacteria. You need to only clean your breasts before feeding if you have an infection.</li><li class="ql-align-justify">Apply few breast milk drops. Massage a few drops of breastmilk before and after the feed to heal your nipples.</li><li class="ql-align-justify">Your doctor might sometimes prescribe you creams to apply on your nipples.</li><li class="ql-align-justify">If you need instant relief after nursing, use hydrogel pads.</li><li class="ql-align-justify">Sometimes the pain is also due to blocked milk duct, massage your breasts with warm water. This will help to unplug ducts and clear the lumps, milk gets released and there is a relief in pain. Note that breastfeeding is the best way to unclog ducts, do not stop breastfeeding due to the pain.</li></ul> These are only temporary relief solutions. You will have to work on the cause of your soreness like poor latch or baby's tongue tie etc. A lactation consultant will be able to help you better. Some women face nipple structural challenges as well. Some of them have flat nipples or very large nipples. In any case, there is no need to worry as generally newborns can nurse on all types of nipple structures. Just ensure that there is a proper latch during the breastfeeding and that the baby is gaining adequate weight. However, here are a few things which might help you if you are facing a lot of trouble:<ul><li class="ql-align-justify">If you inverted nipples, they will naturally protrude out as the pregnancy progresses. Even if this does not happen, your baby will be able to latch on and feed properly. If the baby is facing some troubles, a nipple shield will be very helpful in this case. Consult your doctor or a breastfeeding specialist to help you accustom to the use of nipples.</li><li class="ql-align-justify">If you have flat nipples, they will raise with stimulation. If they don't, do not worry as long as your baby holds on to the areola apart from nipples. If along with flat nipples, you have engorged breasts, your baby might struggle with the latch. In this case, use your fingers to pull the nipple towards your baby's mouth. Your doctor might suggest you to use breast pumps in this case.</li><li class="ql-align-justify">If you have large nipples, it will take your baby a few days to have a proper latch. But if you have adequate milk supply, your baby will get enough milk and gain wait adequately. You can try football hold if you have large nipples.</li></ul>

Breastfeeding can sometimes get overwhelming, not just emotionally, but physically too. Nipple care is very important for the first few months of feeding.

Nipple care

Reduced milk production can be due to pain through breast pump, infection, or poor latching, any breast surgeries you’ve had, stress, high blood pressure, insulin dependent diabetes, obesity, or thyroid. If your baby was born prematurely, it might be a while before your little one gets the knack of proper feeding. And because your baby takes a while to adjust to breastfeeding it too impacts your milk supply. Do not feel guilty about low milk supply as most of the factors are out of your control. Following are the ways which will help you to increase your breast milk production: <ul><li>Evaluate Your Baby’s Latch: Make sure the baby is latching on your breasts correctly.</li><li>Continue to Breastfeed: Your body works on the principle of demand and supply. As you keep feeding, it will produce enough milk. If your milk supply is low, try to express at least 8 times in 24 hours and at least once overnight. Milk producing hormones are secreted the highest at night, so do not skip the night-time expressing.</li><li>Stimulate Your Breasts: Use a breast pump or a hand expression technique to stimulate your breasts after you finish breastfeeding your baby. The extra stimulation will tell your body that you need more breast milk.</li><li>Use a formula supplement: When the milk flow is low or slow, the child may refuse to suck so you can use a formula supplement.</li><li>Make Healthy Lifestyle Changes: Smoking, taking a combination of birth pills, stress and fatigue can also adversely affect milk production.</li><li>Breastfeed Longer at Each Feeding: Your newborn should be breastfeeding for at least 10 minutes on each side. If (s)he falls asleep, try to wake him/her up gently to continue nursing. The more time your baby spends at the breast, the more stimulation you're getting.</li><li>Breastfeed From Both Breasts at Each Feeding: During the first few weeks, breastfeeding from both sides during each feeding will help to build up a stronger supply of breast milk.</li><li>Try to Keep Your Baby Awake During Feedings: Yes! When you are feeding your baby try to keep your child awake and actively sucking so that there is stimulation which helps in milk production.</li><li>Spend Some Time in Direct Skin-to-Skin Contact: The&nbsp;kangaroo care technique that is skin to skin connection between the newborn and mother stimulates their bodies and has a very positive impact on the baby and the mother.</li><li>Eat Well: Eat some milk boosting food such as oatmeal (porridge or upma), spinach, fenugreek, garlic, apricot.</li><li>Drink Plenty of Fluids: Breast milk is made up of about 90 percent water. Drinking about 6 to 8 glasses of water or other healthy liquids such as milk, juice, or tea proves beneficial.</li><li>Try to Get Some Rest: Exhaustion and stress can have a negative effect on your milk supply. Try to take a nap when the baby is sleeping, and know that it's OK to ask for help.</li></ul>

It is very rare that mothers have to deal with less breastmilk production. Nevertheless, there are always ways to deal with it.

Low Breastmilk Supply

Following are the guidelines to be followed regarding the milk intake of a child: <ul><li>Ideally the child should be compulsorily breastfed till the age of 1 year.</li><li>In case if the mother’s milk is not enough or if she’s a working mother and is unable to feed the child, external milk can be given.</li><li>As external milk, give formula milk. You can give formula milk based on your budget and child’s nutrition requirements. Formula milk is rich in proteins and DHA which help in brain development. There are several formulas for milk available - STANDARD formula like Lactogen and Dexolac. PREMIUM formula is also available in market which is very similar to the mother’s milk with DHA and ARA like Enfamil and Nan Excella pro.</li></ul> <ul><li>In any case, DO NOT give animal milk to your child before one year. The proteins in animal milk and human milk are completely different which can lead to consequences. A child can be given animal (cow/goat/buffalo) milk after 1 year.</li><li>A child can be given semi-skimmed milk after 2 years of age. However, do not give complete skim milk to a child under 5 years.</li></ul> <ul><li>There is no age limit for breastfeeding. A child can be breastfed till one or two years or even more than that as long as both the mother and child are comfortable. But sometimes it so happens that even after one year, the child considers mother’s milk as the sole source of food and does not intake any external food.</li><li>REMEMBER that after one year, the child’s nutrition need should be fulfilled 70% by outer food and 30% by mother’s milk.</li><li>When the child feeds on mother’s milk for a while, his/her hunger is satisfied but the child does not get enough nutrition. Hence, such a child can stay malnourished and can lose weight. In such cases, doctors can advise the mother to wean off the child at least during the daytime so that the child starts eating properly and gets proper nutrition.</li></ul>

It is important to breastfeed a child till 1 year. It is not advisable to give formula milk before the age of 1 year.

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