Return to work blues
We had a mom call the office asking for advice to increase her milk supply.
A review of the medical records on her 8 week old baby failed to identify any previous concerns about her supply. He was growing well and she was pumping and freezing milk to be prepared for returning to work.
Upon talking to this mom, she had been back to work a week and her daycare provider said she needed more milk to be sent with the baby. They were running out and mom was frantic about how she could keep up with the amount of milk he needed.
She was regularly pumping three times at work and was sending about 18 ounces of expressed mother’s milk with him to daycare. He was at daycare about 9 hours each day. The daycare provider was giving 4-5 oz bottles (appropriate volume) and running out of milk. Daycare was also concerned about the quality of the breast milk because he was spitting up after feedings.
This baby was average sized, about 5 kg and was growing appropriately. A baby this size needs between 25-28 ounces a day to grow. Mom was nursing before dropping him at daycare and then when she picked him up he usually wasn’t very hungry for a couple hours. He then nursed a couple times in the late evening and woke one time at night to nurse.
As we questioned mom more, the babysitter was feeding him soon after he arrived, then every 2 hours. If he slept three hours, she would offer 4 oz and if he was still hungry, give him two more.
This is clearly a case of over feeding this baby. Mom nursed him before leaving the house. He was on a 2-3 hour schedule before she returned to work with a total feeding frequency of 8 feedings a day. He only woke once at night to feed. Now he was eating 5 times at home and 4 times at daycare. We reviewed with mom a more appropriate feeding schedule for daycare. He would not need to eat for at least 2 hours after mom drops him off. At this age a 4 oz feeding is adequate. Then 3 hours later, another 4 oz after his morning nap. Then he would be awake for a couple hours, take another 4 oz then take a shorter nap. When he wakes up, it is time for mom to come pick him up. We asked to make sure daycare did not feed him at this time. He could wait the 15 minutes for her to arrive.
On this schedule, the 18 ounces was MORE than enough for him to eat at daycare. We find that for most full time moms, their babies should be eating about the same time they are having a pumping break. Moms are encouraged to pump during their breaks and over the lunch hour.
The other piece of this is how fast the feedings were occurring. Babies who eat the full feeding within 10-15 minutes will often ask for more. It takes about 20-25 minutes for the baby brain to register a full stomach. There has been clear data that babies fed by the bottle will overeat. We asked mom to have her daycare watch a video on pace bottle feeding and stretch the feedings to 25 min with 3 burping periods-one after each ounce taken. Mom was very relieved and was able to communicate with her daycare and her baby continued to grow well. The stated problem was not the problem at all. Mom had more than enough milk. By calling, she had saved herself the stress of increasing her milk supply and the risk of her baby being overfed.
Nan Dahlquist, MD, IBCLC, FAAP, FABM, is a member of ABM, Medical Director, Westside Breastfeeding Center at Hillsboro Pediatric Clinic, LLC, and Medical Director, Newborn Nursery at Tuality Community Hospital.
Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.