Q&A: Switching from donated breastmilk because of fussiness

Jessica writes:

"My two-month-old daughter receives donated breastmilk; I was not able to nurse due to a breast reduction surgery I had 12 years ago. We did the same thing with our first son who is now almost 3 and it worked beautifully. The problem is that she seems to be excessively gassy; it bothers her a lot and seems to prevent her from sleeping any kind of a stretch, at least most nights. I was kind of hoping that as her digestive system matured this problem would resolve itself… But it seems to be getting worse not better. Obviously it could be as simple as something in the donor mom's diet thats bothering her but that would be impossible for me to isolate. Wondering if I should go ahead and make the transition to formula? We had hoped to get her to the three-month mark at least on the donated breastmilk but I am a little frantic about the lack of sleep given that I'm going back to work in a couple of weeks. Also I just hate to see her struggling with this and feeling uncomfortable. Got anything for me?"

Hmm. Two things are jumping out at me:

1. 6-8 weeks is the peak of gassiness and fussyness*. I'm wondering if this will resolve itself once she comes around the 8-week mark no matter what you do.

2. If she has problems with breastmilk, she might have problems with formula, too. So it might be going from the frying pan to the fire.

(And yes, I realize this is two questions in a row involving gas. Maybe as a reward for reading through this I'll ask my kids for some bona fide fart jokes and post them tomorrow for you. That'll be a real treat.)

I know it sucks, but I would try to wait a week and see what happens. My guess is that it's going to resolve itself because it's more about her normal stomach development and less about what she's taking in or how she specifically processes things. The other thing is that you could end up spending weeks trying to find a formula she can digest, so it's worth it to figure out if it is an actual digestion problem or just a developmental blip, to save yourself all that legwork.

(Let's just all say what we're thinking right now: I hope she doesn't have to go on Alimentum, because it would be cheaper to feed her liquified Laboutin shoes.)

The tough part of this, of course, is that you can't just change your own diet to see if that resolves it, which means there's an entire stage of variable-seeking that's completely opaque to you. That's frustrating.

But I'm betting there's someone out there who's been through this, even if it wasn't with donated milk. Who's got thoughts or ideas? If she does try formula, would you go straight to goat milk formula, or try cow milk formula and see how it flies? (I, personally, would not try soy if the problem is gassiness, but others might disagree.) What do we think are the chances that this will resolve on its own?

 

 

* My mom, you may recall, was a La Leche League leader in the '70s, so she has almost as big a store of new mother anecdotes as I do. When my older son was a couple of days old she told me about a mother she knew whose baby was having stomach problems, and it turned out there was something wrong with his intestines and his intestine wasn't hooked up to his colon and there was no way out for everything he was taking in! Of course she thought she was just telling me a random story, but when my older son hit 6 weeks and was constantly gassy it was all I could think about, and even though he'd been pooping just fine for weeks I still was convinced there was something wrong with his system. Why we romanticize this newborn stage is beyond me...

Comments

[decaturmamaoftwo]

Maybe try elevating your baby a bit (rolled up towel under the mattress) to help gassiness/reflux? Also - doing the leg-curls to help her relieve her gas symptoms before bed might help. (Lay baby on her back, facing you. Tuck both her legs together and gently push in and pull out about 10-15 times. Also - rotating her legs together in a clockwise loop can help relieve digestive distress.) I agree that she may have formula issues just as well as she has milk issues. Plus the age (8/9 weeks is a 'fussy' phase, like Moxie said).

[Shannon LC Cate]

Go with a cow's milk formula and try for a week, then move on if it doesn't get better.

Mainly, though, remember that formula is not poison. Organic formula has far fewer environmental toxins than breast milk, for that matter.

I am all in favor of breastfeeding when it's good for mom and baby. My BFF just weaned her 5 year-old. They had a great five years and I was her last supporter when everyone told her it was "time" but she and her son didn't agree.

BUT: my adopted children never had a drop of breast milk. We ordered organic formula in bulk online (made the cost lower than buying conventional at the grocery store) and nobody's kids could be healthier or brighter. (Mine are now seven and five and between them have had maybe three ear infections, for example.)

I think that in the developed world, where we have easy, cheap access to clean water, this feeding question is overblown. If one way of feeding is causing problems, switch. Your child will be fine.

[Bird]

Ugh this is no fun. Unfortunately if it is something in the donor mother's diet, the most likely culprit is cow's milk which means formula won't help unless you get the super expensive hypoallergenic stuff.

How does her skin look? My 11 week is dairy sensitive and while the gassiness made me suspect, it was his skin that really tipped the scales for me. His baby acne showed up way earlier than it was supposed to and wasn't going away. As I was trying various dietary changes the skin was a better barometer than fussiness since it's less subjective. (The baby acne cleared dramatically within 3-4 days of cutting dairy; I tried to cheat and eat some cream cheese and the next day it flared up dramatically.)

Okay that was really a long-winded way to say if she also has skin issues I might pursue the food sensitivity thing but if not I'd wait it out another few weeks.

[fonte]

My baby suffered hugely with gas from 2 to 8 weeks and nothing I changed in my diet seemed to have any effect. My GP said it was just his immature digestive system and although at times I was convinced there was something else wrong sure enough we're now at 12 weeks and he's so much better.It was really awful at the time though, they just seem so tiny to be suffering like that. One thing that really helped him was to do a short abdominal massage before every feed focusing only on the area below his navel(waterfall, sun and moon strokes, raising his legs with your hand on his tummy and an inverted u)this seemed to help keep his system moving and reduce the pain. I also kept him upright for 30 mins after feeds and elevated his cot. Not sure if this applies to your baby but it might be worth trying before experimenting with formula.

[Lyndsay]

I know she's bottle fed, but has she been evaluated for tongue tie?

[Elizabeth]

Re: Moxie's last point about random stories that freak out newbie mums - I completely sympathise! There should be a rule that no one is allowed to say anything negative to a new mum (unless it's another new mum needing to vent/get support) - they'll either end up worried or sad. Or maybe I was just especially labile in the first six weeks or so . . .

[Dr. Confused]

Hate to say this but it *might* be the breastmilk.

My daughter, who I breastfed, had really similar issues. Gassy, colicky, in pain, green poop that was sometimes downright frothy (think cappuccino foam). The pediatrician diagnosed a sensitivity to cow's milk protein in my milk and I went off dairy for several months.

In retrospect, my current theory is that the ped was wrong. I think the actual problem was oversupply, causing an imbalance in fore-milk and hind-milk, and that my baby was only getting fore-milk. I had bad breastfeeding technique (I didn't realize the pain I was feeling in my other breast after a few minutes of feeding was let-down, so I would switch breasts to feel better) and I was pumping because I knew I had to go out of town for three days at the six-week mark. This just made things worse and the poor little thing screamed all the time. It got better after my 3-day trip, in which I used a terrible manual breastpump and got horribly engorged, thus decreasing my supply. I nevertheless had so much excess milk that I brought a suitcase full of frozen bags with me when I moved across the Atlantic and kept her on breastmilk (not exclusively; she was eating solids by then) for four months after I stopped pumping.

When I think of someone who might donate breastmilk, I think that person is very kind, but also, might have more milk than they need for one baby. That is, have oversupply issues. So the milk you are using might be high-water-and-sugar, low-fat foremilk, as opposed to the higher-fat, richer hindmilk.

Whether my theory is right, or whether my pediatrician was right in diagnosing milk sensitivity, either one is a possibility with your child.

Or it could be something else entirely, as Moxie and other commenters have said.

Sorry not to be more helpful, but I thought my data point might be useful.

[SarcastiCarrie]

I like Dr. Confused's answer because I was wondering who would donate breastmilk (and how the heck you get on the list for that). So, to the real question: what does the poop look like?

When I used fenugreek to increase supply for pumping, the baby's poop turned green and frothy and he got gassy and uncomfortable because I was making less rich milk, so it's a good theory. I stopped fenugreek and the poop went back to slimy, mustard-seed yellow...just like breastmilk poop should be.

[Goyt]

Eliminating dairy from my diet worked wonders for both my sons. I guess you cannot get a dairy free donation source?

There is a place in Houston called Heights of Health that has been a godsend for many parents in figuring this stuff out. They may be able to point you to a similar resource in your neck of the woods.

Good luck.

[Tine]

I think Moxie's got it right. The problem *might* be the breastmilk. But it's just as likely *not* the breastmilk. If baby is otherwise healthy (peeing & pooping appropriately, growing well, reaching milestones within reasonable time frames) I'd probably wait it out and try some other things to relieve the gas/fussiness first.

[Lauren]

My little one had similar symptoms when I ate dairy, beans, or cabbage/broccoli. It did get better as she got older, but it also helped to give her probiotics - you can put them straight into the bottles.

[Dr. Confused]

Here's a good article on the foremilk/hindmilk thing. I'm even more convinced now that the oversupply was our problem.

http://www.llli.org/faq/foremilk.html

[Wendy]

I have nothing to add other than I love this place...supportive, pragmatic moms offering advice without judgement. So refreshing! Go moxie-ites!

[Lisa]

Another data point for oversupply causing foremilk/hindmilk imbalance, for the same reason as Dr. Confused. I addressed the problem with block feeding, but you don't have that option with donated milk.

Also: Don't know how these things work, but is it an individual donor or through an organization? If the latter, could they switch your source?

Most likely, however, I'd guess Moxie's take on it is correct - mostly since it's a new problem rather than one there since day one. You may want to wait, then if the problem persists, tinker with source (either as above or via formula). Good luck -

[rebecca]

Coupla things...dairy issues will eventually show themselves with blood in poop (even hidden blood so it might be worth asking the ped to check- its a simple swipe test). My boy had it at 3 months, my girl at 6 weeks. I dumped all dairy from my diet and they improved tremendously. I at first thought it was the hindmilk/foremilk problem with me too but it SO wasn't. The ped wanted to try all kinds of formulas (with the $$$$ Alimentum as a last result). Ask if there is blood in the poop and if there is, go directly to formula. Also- all kinds of moms donate milk. It is very big among moms who may have lost a child, had a stillborn, etc. Not all are moms with a zealous supply, for what it's worth.

[G's Mum]

I agree with Moxie. Also I am not sure if you are getting the milk from a bank where it is pasteurized or if your are informally milk sharing. You *might* be seeing some problems from bacterial contamination of the milk if it is not pasturized. If the symptoms get worse or a fever develops you migt want to consider seeing the doctor in case of infection.

The age your LO is at is a tough one in any event. We are going through it again with our second and my current theory is that it is developmental. I would also try the elevated cot, the massage, all that stuff. If no relief, try formula since at least then you would know exactly how it was prepared and the bottles / containers sterilized, etc.

On the issue of food sensitivities, I know many people believe that what the mother or milk donor eats affects the milk. When we were battling very similar issues with my first baby, our pediatrician said there was zero evidence to support that hypothesis and that he had seen desperate mums on such restricted diets that they were at risk for malnutrition themselves from trying to eliminate allergens from their breastmillk. So the theory of dietary sensitivity and breast milk may be just an old wives tale. I know loads of women firmly believe that dietary changes helped their babies though, so their experience can't be discounted - I just note his comments as a data point here.

@sarcasticarrie or anyone else who is interested, information on a donor milk bank can be found by googling our BC Women's Hospital MIlk Bank. I am a milk donor and I'd be happy to share my experiences about it if you are interested - leave a note here and maybe we can connect.

[hush]

Hey Jessica, I had my breast reduction surgery 14 years ago. Best decision I ever made for my overall health, even if it meant I'd never have a full supply of breast milk (despite the world's coolest LCs helping me, my breasts could only ever produce a few meager drops).

My 2 primarily-formula-fed infants are now 4.5 and almost 3 (tomorrow!) They are awesome and healthy. I'm happy to report my oldest has tested "gifted" (don't gag), and neither kid has ever had an ear infection, nor any illnesses lasting more than a day. And we haven't been raising them in a bubble - they've been exposed to all the usual childhood germs in daycare, in the care of babysitters with other kids, and in Montessori preschool for ages.

In short, you should count formula as another wonderful feeding option.

[Arwen]

For gassiness, I always suggest probiotics. Our firstborn was very gassy, and her brother seemed to be heading in the same direction when a friend suggested probiotics. Started giving them to him around 4wks, and our noticeably gassy baby suddenly had none. After just a few days of probiotics, he had no gas ever again that was painful enough for us to notice. We did probiotics again with our twins, and again, neither of them was ever gassy-fussy that we noticed. It was amazing.

Also worth noting - all our kids were exclusively breastfed, and with our firstborn, buying into the mother's-diet theory, I did a lot of elimination (including cutting out dairy completely for two months) and it never made a difference. With her brothers, I ate whatever I wanted and nothing seemed to bother them at all.

We like HLC Neonate powder, which you can get pretty easily online and which isn't too expensive comparatively (about $10/month).

[Loz]

For anyone (doctor or otherwise) saying that mum's diet doesn't impact on milk, I call phooey. It is a demonstrated fact that what mum eats affects the composition and contents of the milk.

The correct proposition would be that some kids don't react to what is in the breastmilk, and good for them! However, others (many) do. I have three out of three kids to prove it (two reacted to cow's milk in my milk and one to soy - unfortunately the soy reactor was the twin of one of the dairy reactors - DOES THAT SEEM FAIR, UNIVERSE?).

If baby was fed directly from the breast it might well be foremilk/hindmilk imbalance, but in my experience of having an exclusively ebm fed baby (my milk) while also feeding her twin from the breast, while also having galloping oversupply (400ml extra a day, ON TOP OF FEEDING TWINS), ebm by bottle doesn't have the same exposure to oversupply issues as directly from the breast. That is because pumped milk combines both foremilk and hindmilk, while a breastfeeding baby gets the foremilk first. The bottle fed baby *might* get more foremilk than ideal, but they will still generally get quite a bit of hindmilk, particularly if donor mum is pumping after feeding as most do. My ebm bottle fed baby was not gassy at all once I stopped dairy, but her breastfed brother was as windy and refluxy as all get out until I stopped pumping for her at 8 months (ie when he was regulating supply himself).

I'd start with goat formula but only because my cow's milk protein intolerant daughters are fine on goat milk.

Probiotics are always worth a shot, and babies usually love the powder straight off the spoon or (clean) finger. You can get dairy free ones.

Best of luck
Loz

[Schwa de Vivre]

I went dairy-free for a year when I breastfed my son. It didn't take care of all the colic, but perhaps about 90-95% of it, which was AWESOME. In retrospect, I'd try the probiotics first. (We didn't have the green frothy poop problem, but I wonder for that if there's a good way to add some fat to the milk if you think that's the issue. I'd go straight for the fish oil myself, because they don't know it's gross yet -- my 4 y.o. squishes the capsules in his mouth still, and occasionally all over his shirt....)

We did all 5 of the S-es from The Happiest Baby when we could; at night, our child slept for MONTHS swaddled really tightly in a swing (semi-reclined, but more or less upright). And we used so much gripe water that I used to seriously think about buying stock in it. Gripe water's good to have on hand and a quick, inexpensive thing to try: it should give you nearly instant results, enough so that you'll know a) whether it's helpful, and b) whether it works well enough to take care of the issue. We used the Mommy's Bliss brand; there are others, and you could also make your own, though you'd want to have a good understanding of the proper dosage. I recently heard that some gripe water contains simethicone/the stuff in Mylanta, so make sure to read the ingredients and not double-dose your baby.

I heard that 4 months is when colic magically goes away; magically, my son's didn't.

If you switch to formula: We supplemented occasionally with soy formula, and it didn't cause any problems. Personally, I wouldn't use that exclusively unless I had to. I understand that some dairy formulas have smaller proteins, and I'd try those or goat's milk first. I think the taste of goat's milk formula is fairly strong, so you'd want to start it younger -- my son drank one bottle of it then refused at 8 months.

[Heather]

The piece that made me wonder about foremilk/hindmilk in the donor is the baby's behavior--very like my (very limited, anecdotal) experience with babies with that issue.

If the donor does have oversupply, it is absolutely possible that she is producing and pumping mostly foremilk.

[Mavis]

No advice, just empathy, for the mom and baby.

For everyone else, here's an organization i'd hoped to donate to but never was able:

http://www.milkinmamas.com

An LC friend told me about them. I follow them on Facebook and the posts about the donor moms are lovely, moving and inspiring.

[Elizabeth Anker]

I would agree with the poster that suggested asking the pediatrician to do an occult blood test on a poopy diaper. At about 2 1/2 months, my daughter (bottle fed exclusively breast milk due to latch issues) started getting gassy, fussy and over the next few months eventually started refusing bottles. I was very unenthusiastic about the doc's suggestion to eliminate dairy, but once we found blood in the diaper, I cut all dairy out of my diet and she's happy as a clam now at 8 months. We recently switched to Alimentum due to nutrition issues for me. A suggestion for Alimentum moms - call your health insurance company to see if they will cover all/part of the cost. And if they say no, call your pediatrician, and then Similac and ask for their help - they have a department dedicated to helping you obtain coverage.

[mom2boy]

I've got no advice - mine was mysteriously fussy/not sleeping for way longer than OP wants to hear - but reading this and realizing that I have a five year old puts me squarely in the "this too shall pass" camp and I totally get it in a way no new mother really can. Hang in there new moms!!

[Erin]

The whole question of hind/foremilk is mute if the OP is getting her donor milk from a milk bank. Milk bank milk is composed of the milk from several mothers and is always specially mixed to have the right balance of hind and foremilk. OP could also try to get her hands on Milk Bank milk if she can get a prescription from her pediatrician. It might be too expensive, but it's worth a shot. A milk bank might have milk available that's specially donated by mothers on low or no dairy diets. (I know all this because I donated to a milk bank, and was on a no-then-low dairy diet while donating, and that's something they specifically requested.) I agree with the other posts who suggest that most donating mothers pump AFTER nursing and that it is unlikely that baby is getting too much foremilk (in which case baby's poops would be greenish rather than yellow anyway).

Honestly, I think we (as a society) are often too quick to panic about the newborn stage as Moxie says, and want to "fix" something that isn't necessarily a problem, or is super annoying and challenging but will go away with time. And while I agree that some babies are sensitive to what's in their mother's milk (like in @Elizabeth's post), I feel like milk sensitivities are overdiagnosed rather than underdiagnosed. Peds and LCs tend to rush to a "Oh yes there must be a problem - switch to formula/eliminate dairy" when really it's a phase the baby is going through that will be over. My babies' (both of them) sleep went to hell at the 8-10 week mark and they didn't recover for months and months. No problem, just "bad" sleepers.

Presumably, if the milk is being donated informally and not through a bank, the OP could just ask the donor maybe to cut down on dairy and see if it helps?

[hedra]

@G's mum, your ped was wrong about the zero evidence. Johns Hopkins produced evidence that cow's milk elimination for five weeks resolved most cases of unexplained fussiness and sleep disruption, which then returned immediately on reintroduction of cow's milk. Milk/Soy Protien Intolerance through breastmilk is fairly well understood at this point, but the challenge is a) whether you can eliminate ALL traces and b) whether it is worth doing so.

MSPI is generally outgrown (more than 90% at 3 years), and a lot of babies outgrow by that 8 week window. So waiting is definitely one option.

If it is pooled milk, odds are good that the balance is good, since they do test for fat balance in milk banks. I've donated privately, and while yes, I had an oversupply, I used the milk bank protocol, which requests that you ensure hindmilk is also pumped (they had tips for how to be sure of that, and no, I don't have the sheet anymore). Remember that the milk banks' first clients are critically ill preemies and infants, so they are very concerned that the fat balance be good. The last thing at risk babies need is a foremilk/hindmilk imbalance, even if that would be better than formula-induced enterocolitis.

For the asking mom: There's a probiotic available in the UK/EU that is a specific strain for colic, which seemed to reduce both reaction and gas from diet as well. PubMed lists it as Lactobacillus reuteri DSM 179838/17938)(10(8) colony-forming units). It has been studied for at least 4 years now, several double-blind/randomized trials. It may be worth considering. That's where I'd go first, myself - as part of the issue with pasteurized donated milk is the lack of delivery of beneficial bacteria, while still delivering the microsugars that feed them.

[hedra]

Oh, and c) whether that's the actual problem. MSPI is pretty common by comparison to things like IgE allergy, but it is NOT the only cause of fussiness, gas, colicy behavior, etc., and is not even the mian cause. Plus it can be really frustrating to determine if elimination worked, and you have to start counting days again from every mistake someone made with ingredients - it took me probably four weeks to get to two weeks of elimination.

Blood in stool is a nice clear sign that you found MSPI. We had dramatic blood in stool at 5 weeks with B, plus profuse vomiting... it was pretty clear sign, and he improved with full elimination of dairy from my diet, including traces, flavoring, etc. And immediately reverted when I 'tested' if he was better yet, and then it was two more weeks of full heck and three weeks after that to get the lower grade symptoms down. Whee.

Hopefully you can get insurance coverage of fully hydrolyzed formula if you need to go that way.

[tina]

One thing that can cause fussiness that hasn't been mentioned is yeast overgrowth. Excess yeast could be present in donor milk (freezing does not kill yeast) although it is unlikely that donor mom would not be aware of it. Or it could just be in baby's system, particularly if they have had antibiotics (either directly or if donor mom had abx at any point). Thrush in the mouth or yeasty diaper rash would be symptoms that go along with this.

If it does turn out that milk protein allergy is the issue, many cases resolve around 6 months when baby's gut is more mature, particularly if the gut is given a chance to heal from the damage that milk proteins do. If immunological protection conferred from breast milk is desired, you could try going back on donor milk at that point.

[Sheila]

Been there, done that, read the book. :-)

Start on a probiotic. Our breast feeding medicine specialist had us do that and it really makes the difference. Also made the difference for so many moms I know on a food allergy board.

We use BioGia infant probiotic drops. 5 drops a day. Its about 30 dollars and lasts one month. I get it at Walgreens. Definitely call ahead and make sure they cary it.

I would DEFINITELY try this before switching anything. Remember to do one thing at a time. Hope it works out!

(I had two MSPI kiddos and the probiotic got us through. Formula can also be harsh on the gut so either way I'd get your kiddo on that stat!) :-)

Here is a link: http://milkworks.org/images/stories/pdf/PROBIOTICSapril2012.pdf

[Shannon LC Cate]

Hey, just want to say thanks to Dr. Confused. I've never heard about over-supply being a problem but that makes tons of sense. My SIL is breast-feeding mornings and nights and pumping for the rest of the day while my brother is home with the baby. They have tons of frozen milk stocked because her supply is great. It never occurred to me that could actually be a "colic" causer. Will share with them.

[Jessica]

This is the OP - I can't thank all of you enough for your kind and knowledgeable advice (and thank *you* Moxie for opening it up to the group.) I decided to go ahead and do a trial run with some formula the last 3/4 days and the results have NOT been encouraging. :( Gas and uncomfortability issues seem just the same; it may be that I just have very unfortunate timing because I feel like she might be having a late growth spurt - she's been insatiable and SO fussy. Mommy instinct says go back to the donor milk and wait it out. I found the fore milk/hindmilk question quite interesting...my donor (informal) is pumping for her own 4 month old as well so I may ask if there are any issues there. I'll definitely try the probiotic; I know I have had yeast issues myself over the years so there could very well be something to that.

I spent a good part of today pacing the floor with her whining or crying, doing the bicycle legs, crying myself, you get the gist. It's nice to know others have been there and to feel supported. Thank you so so much.

[Jessica]

This is the OP - I can't thank all of you enough for your kind and knowledgeable advice (and thank *you* Moxie for opening it up to the group.) I decided to go ahead and do a trial run with some formula the last 3/4 days and the results have NOT been encouraging. :( Gas and uncomfortability issues seem just the same; it may be that I just have very unfortunate timing because I feel like she might be having a late growth spurt - she's been insatiable and SO fussy. Mommy instinct says go back to the donor milk and wait it out. I found the fore milk/hindmilk question quite interesting...my donor (informal) is pumping for her own 4 month old as well so I may ask if there are any issues there. I'll definitely try the probiotic; I know I have had yeast issues myself over the years so there could very well be something to that.

I spent a good part of today pacing the floor with her whining or crying, doing the bicycle legs, crying myself, you get the gist. It's nice to know others have been there and to feel supported. Thank you so so much.

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