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Sunday, February 23, 2014

Breastfeeding: Block Feeding for Overactive Let-Down?

I've been reading in the BFP forums that there are some concerns on newborn or fairly new babies having trouble coping with her fast milk flow. During feedings, these babies would sputter, cough and then pull themselves off the breast crying. Mothers of these normally assume that she has an overactive let-down (OALD) and would, on my occasions, start using a “block feeding" strategy.

Before I get ahead of myself again...I better explain better and with proper research.

What is Block Feeding?
Block feeding involves restricting baby to one breast for 3-hour or longer blocks of time before giving the other breast. It is very effective at bringing down milk production when a mother is making way too much milk. Allowing the breasts to stay full for a set period of time sends the signal to slow milk production.

Occasionally if baby is nursing in a very, very frequent pattern - meaning that the baby is nursing hourly or even closer than hourly and experiencing marked fussiness and perhaps has consistently green stools - a loose block pattern may be suggested as well.  It is good to note that frequent nursing - meaning about every 2 hrs from start of one feeding to start of next feeding - is totally normal.

This is totally different in normal breastfeeding patterns wherein breastfeeding experts recommend "baby led" or "feed-on-demand" nursing patterns. Baby should be allowed to finish the first breast, before burping and offering second side. This may mean baby will nurse, for example, 20-ish minutes on first side, burps, then may or may not be interested in the second side.

**Note: Time of the breast, doesn't mean that the baby is effectively feeding.  You have to still observe the baby on the breast, wherein the following conditions are met: (1) long gulping is done - "long pause", (2) proper weight gain is observed but compared via exclusively breastfeed babies chart, and (3) baby is happy and thriving.

Block Feeding DO's and DON'Ts
DO Consult with a breastfeeding expert, such as a board certified lactation consultant. An expert in breastfeeding management can assess the situation and help mom determine if she might benefit from using a block nursing pattern, and if so, what type of pattern to use. Most experts recommend starting out with smaller blocks of time and increasing them if needed after a couple weeks.

DO Use this strategy especially in some cases where oversupply (aka “hyperlactation” or “overabundant milk production”) can decrease quality of life for both mother and baby. For a mother, the drawbacks include regularly full and uncomfortable breasts and recurring plugged ducts. For the baby, oversupply can cause a very fast milk flow that can be hard to manage. In this case, block feeding used for no longer than 1 week would be good for both mother and baby.

DON'T What seems to be more and more common, though, is the assumption that any struggle with milk flow is due to OALD or oversupply, when there is usually another cause. As a result, some mothers bring down their milk production with block feeding when their supply is actually at a healthy level, leading to other problems, such as slow weight gain.

Remember that it takes practice and maturity for babies to learn to coordinate sucking, swallowing, and breathing during breastfeeding. Some episodes of milk flow struggles and pulling away are completely normal and are not necessarily signs of OALD or oversupply.

How to Know if Block Feeding Will Help?
The most reliable gauge of whether block feeding may be helpful is baby’s weight gain. If breastfeeding is going well, during the first 3 months, most babies gain on average about 2 lb/mo. (0.90 kg/mo.). If baby’s weight gain is double this or more, block feeding for no longer than 1 week makes sense.
If baby’s weight gain isn’t this high, it is likely that block feeding will cause more problems than it solves.

How Long Does It Take?
Block nursing is not an "instant fix" for oversupply, but it almost always helps if given enough time to help. In mild cases of oversupply, it may only take a few days to a couple weeks to see good results. In more severe cases, it may take several weeks to a couple months to see good results; although almost always mom will see improvements in the situation within just a few days of implementing the use of the block pattern.

Do I Need To Continue Using the Block Pattern, Once Supply Adjusts?
No, one doesn't need to continue using a block pattern once the situation is resolved. Mom can go back to using a "normal" nursing pattern of offering first breast until baby is finished, then burp and offer second side. If things continue to go well, there isn't a need to do any additional adjustments. If the symptoms of oversupply begin to return, she can resume a block nursing pattern once more for a while longer, and then later on can see if a "normal" nursing pattern will work.

As suggested above, it is recommended that mom locate a board certified lactation consultant (IBCLC) to assess each individual situation, provide assistance, information and support.
Alternatives When Baby Struggles with Milk Flow
What can you do if your baby’s weight gain is average but she is struggling with milk flow during breastfeeding? The best strategy is using feeding positions that give baby more control over flow. The most difficult feeding positions for babies from a milk-flow standpoint are those in which milk is flowing downhill into their throats, such as all those in which mothers sit upright.

I find either the Australian Laid-back (infant to toddler) or the Japanese Sitting positions worked well for controlled milk flow.

Australian Laid-back position

Japanese Sitting Position

Other positions can be found here.

If baby continues to have consistent problems with milk flow, it's time to see a lactation professional to check for anatomy, swallowing, and breathing issues.

References
Caroline, G.A. and van Veldhuizen-Staas, C. G. Overabundant milk supply: An alternative way to intervene by full drainage and block feeding. International Breastfeeding Journal 2007; 2:11.

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