Decreased Breast Milk Production
I recently realized that my breast milk has decreased to less than 2 ozs per time. I pump 35 minutes. I was exclusively breastfeeding by recommendation of my doctor. No bottles used. Now my 10 month old will not take any type of milk - breast or formula from any type of sippie cup, bottle or regular cup. I'm trying to mix in with her food and nurse what I can - but she has dropped 2 lbs the past 2 months. I am feeding well balanced diet and giving Poly Vi Sol with Iron vitamin - and she is a good eater. Any ideas how to make up the missing calories and nutrients? She does not even consume 5 ozs of milk per day. Thank you!
“Worried Sick Momma”
Dear “Worried Sick Momma”,
Sometimes babies wean themselves from the breast or bottle on their own and seem to prefer solids. In other instances, a child may want to continue to breast-feed but the mother’s milk supply is diminished and the amount of milk produced does not satisfy the child. When this occurs the child usually refuses milk from a cup because they prefer to breast-feed.
A mother’s milk production can slow down for many reasons. Factors that interfere with milk let-down include hormonal problems, fatigue, excessive amounts of coffee or soft drinks high in caffeine, smoking and some drugs. (1) In many cases, a reduction of milk supply can be caused by maternal stress. A mother’s hormonal response and let-down are vulnerable to brief periods of stress. The stress can be due to either a physical cause such as pain or emotional disturbance. (1) Situations such as divorce, loss of a loved one, moving or worry over a sick child can all temporarily affect the mother’s ability to lactate for a short while. The return of milk supply is possible with continued sucking or pumping of the breasts providing that the mother is motivated to continue to breastfeed. (1)
This first step in trying to remedy the situation is to figure out the cause of your child’s decreased breast milk intake. Is your baby not interested in breastfeeding because she prefers to eat solid food? Or is she interested in breastfeeding but there just is not enough milk. If your daughter continues to give you cues that she wants to breast-feed, by pushing her face into your breast and then crying after breast feeding for only a few minutes, this would be a sign that she wants to continue to breast-feed. If this is the case, and you wish to continue breast feeding, there are a few measures that you can take to regain your milk supply.
First, determine if there are possible stressors in your life that could be affecting your milk supply. Address these issues and discuss them with a health care professional if necessary. You may also want to discuss with your doctor other factors that could be affecting your milk supply, such as your diet, any medications that you may taking or possible hormonal abnormalities.
Secondly, remove potentially disrupting factors from the feeding environment. Irritations in the area where the baby is fed may also affect a mother’s ability to breastfeed. There have been reports of mother’s who identified irritating factors in the home that caused difficulties with breastfeeding. For example, one mom discovered that barking dogs disturbed her every time she sat down to breastfeed her infant. Once the environment was changed the problem with breastfeeding went away. (1)
The next step in trying to regain your milk supply includes stimulation of your breasts. Suckling on each breast every 2 to 3 hours is the most effective means of stimulating breasts to produce milk. (1) As long as suckling occurs 8 to 10 times in a 24 hour period it is okay to spread the suckling out at night for 5 to 6 hours. You can accomplish this by bringing your baby to the breast or by using a breast pump to stimulate lactation when it is not feasible to breastfeed. Massaging of the breast before and during pumping in motions similar to a breast self exam has been shown to enhance prolactin secretion. (1) Therefore incorporating massaging into the pumping routine may help milk production.
On the other hand, if your baby is not interested in breastfeeding, turning her head away and resisting your attempts to put her to the breast, she could be trying to wean herself. If this occurs and she prefers to eat food instead, then you can adjust her diet so that she receives the proper amount of calories. In order to determine if her intake is sufficient, perform a 24 hour food diary.
The food diary should include everything that your daughter eats and drinks and the amount of calories in each item. Baby formula typically contains 20 calories per ounce. Infants require 80 to 125 Kcal per Kg of body weight per day during the first year of life. (2) If your daughter’s calorie intake falls short from what is expected you should bring the food diary into your Pediatrician’s office so that you can discuss ways to increase calories in her diet.
If your daughter needs more calories you will need to adjust her diet. A few suggestions include eliminating water intake, avoiding low fat food and adding formula to the solids that she takes. You can add formula to cereal, oatmeal, pastina, farina, mashed potatoes, vegetables and macaroni. In addition, you can choose foods that are nutritious and high in calories. Foods that are high in calories include bananas (22 calories per ounce), avocados (25 calories per ounce), olives (30 calories per ounce), prunes (46 calories per ounce), mushrooms (62 calories per ounce), eggs (72 calories per medium size egg) and cheddar cheese (120 calories per ounce). Although your daughter may not like some of these foods, you can puree them and add them to her meals in order to hide the taste while adding calories at the same time.
Just remember, you should wait 3 to 5 days before introducing a new food into an infant’s diet. This time is needed to determine if there is a reaction to the new food. If two new foods are given at the same time and a child develops a reaction, you will not be able to tell which food caused the problem.(3) Also be careful to give only soft items that are cut into small pieces. Avoid foods that are round in shape or large pieces because these types of food can pose a choking hazard. (3) For example, your daughter should not eat whole olives because she can choke on them. But you can add a tablespoon of olive oil to her pasta or vegetables in order to add calories to her meals.
Whenever a child loses weight and becomes disinterested in a certain type of food it is a good idea to rule out a food sensitivity, a food intolerance or malabsorption problem. Infants with malabsorption problems tend to have difficulty gaining weight because their body is not able to properly digest a certain type of food. For example, both cow’s milk allergy and wheat intolerance , also known as Celiac Disease can lead to problems gaining weight.
Babies with a Cow’s milk allergy develop symptoms including crying, irritability, colic, feeding refusal, failure to thrive, vomiting, regurgitation, wheezing, and sleep disturbances. (4) Children with Celiac Disease tend to develop symptoms between 6 months and 2 years old, following the introduction of gluten into their diet. The typical symptoms include impaired growth, abdominal distention, chronic diarrhea, muscle wasting, poor muscle tone, poor appetite and lack of energy.(5)
You mentioned that your baby’s symptoms began two months ago, when she 8 months old. If this happened to coincide with the introduction of new food you may want to consider the possibility of a food intolerance or malabsorption. It would be a good idea to take note of any changes in your daughter’s stool, the presence of signs of abdominal discomfort or delays in development. If your daughter is having bulky stools, greasy stools, blood or mucus with the stool, loose stools, gray stools, excessively foul smelling stools, vomiting or signs of abdominal pain you should bring this to your doctor’s attention. These symptoms may be a sign of a food sensitivity, Malabsorption or more serious health condition.
It can be very frustrating for a mother when her child doesn’t gain weight. Know that sometimes babies go through phases of refusing a certain food or drink and then go back to eating it again. In some cases the cause can be something as simple as mouth pain due to teething. It is important to follow up with your Pediatrician during this difficult time so that your daughter’s growth and development can be properly monitored and you can receive the support that you need.
I wish you and your daughter well.
For more information about topics discussed you can read related stories on the Pediatric Advice website:
Failure to Thrive
(1)Riordan J. A Practical Guide to Breastfeeding. St. Louis Missouri: The C.V. Mosby Company.1983: 163, 221-289.
(2) Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990:230.
(3)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 305-306.
(4)Edmunds A. Gastroesophageal Reflux Disease in the Pediatric Patient. Therapuetic Spotlight. 2005. August:4-12.
(5)Gelfond D. Fassano A. Celiac Disease in the Pediatric Population. Pediatric Annals. 2006.35:4:275-279.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice About Infant Nutrition