I didn't think a lot about breastfeeding my first baby.  I really had no expectations, I was very naive and uninformed.  I thought it would all just happen!  In fact things weren’t as simple as I’d hoped.

My first baby had a high palate so couldn't latch on. She also had reflux, had low weight gains every check, and was syringe or spoon-fed milk because she couldn't suck. She was allergic to cows milk formula so had to have soy milk at double the cost. She was fed breast milk for as long as I could squeeze it out, about 6 weeks.

All the health professionals told me I should only be breastfeeding and refused to give advice on formulas. No one could get her to latch on properly though and no one could see it wasn't going to work.  I think she might have died had I not done the right thing and got some nutrition into her.  This was very time-consuming and took an hour a feed for every feed.

The whole breastfeeding thing made me feel inadequate.  I was continually worried about my baby's health.  I felt dishonest as I lied to the nurses and Plunket nurse, because if you said you were bottle feeding they would go over the whole breast only thing. - even though they couldn't get baby to feed either.  This did happen 21 years ago, I hope things have changed!

It would have been great to have the easy option of breastfeeding. The guilt and pressure was overwhelming. My baby is now 21, has just this year finished her degree, is fit and healthy and has too many boyfriends. Thank goodness I knew what I was doing, even if all the so-called professionals I asked for help didn't. They told me they were not allowed to give advice on formula.

My third baby also had reflux. I had planned to breastfeed this baby.  This time I had mastitis every two weeks, high temperatures, vomiting, painful breasts, tummy pain and constant diarrhea from the antibiotics. I also had to give her a syringe of thickening medication just before every feed.  This time I felt cheated by mother nature.  There was nothing Plunket, doctors or midwives could do.  They recommended the bottle due to having to medicate each feed.  The reflux was serious; my baby was in hospital at four weeks because her weight was the same as at birth.  I don't think the professionals considered the mastitis as reason to bottle feed, but after 8 long painful weeks I certainly did.

Switching to bottle feeding gave me a chance to recover and be a mother.  I could enjoy my baby and get on with life. There were two other mini people in the house who needed me. The two babies I had that were breastfeeders, were breast fed, and it was so easy. Coincidently they were the boys!
 

Health professionals diagnosed Silvia as “probably having colic”. I was told that she was healthy, that “she would grow out of it” and that I should continue to do what I was doing, as there was nothing I could do apart from comforting her. 

For more than three weeks I had the run around, while my baby was getting in more and more pain.  Even in this world of motherhood, sleep deprivation and self-doubts - Mothers trust your gut feeling as you know your baby better than anybody else.  If you think there is something not right, be persistent in the face of health professionals telling you that “it’s normal” and putting you in the “overanxious mum” category.  Look for alternatives.  Research it yourself by talking with friends and other mums, by reading books and parent magazines, and by searching the web.

The New Zealand book “Oh Baby” by Kathy Fray gave me the first clues.  Silvia’s symptoms matched either “lactose intolerance” or “colic”.  Health professionals dismissed “lactose intolerance” as (a) it is very rare, though it is not as rare in Scandinavia and I am Danish, and as (b) the baby loses weight, where as Silvia had good weight gains.  My experienced friend and mother of four knew that there was an easy non-invasive test for lactose intolerance using a bit of poo.  In the end, I ordered and paid for a reducing substances lab test which tested positive for lactose in the poo. The positive result was a clue though it was not conclusive as breastfed babies can test positive. 

Information from the web helped me to focus on “lactose overdose” rather than “lactose intolerance” (web links are included at the end).  Good weight gain is an indication of lactose overdose, where as babies with lactose intolerance lose weight.  The web also provided guidance on management, and my GP supported the management approach that I suggested.

FACT, there was something that I could do.  Within two days of making changes to Silvia’s feeding and increasing the hind milk, Silvia’s pain reduced by about 80%. Within a week Silvia was pain free and her acid diarrhoea had completely stopped.  Her hours of crying in pain stopped and she could lie down and sleep again.

Silvia had “lactose overdose” or “functional lactase deficiency” which is a temporary problem related to the immaturity of an infant’s digestive system.  An overload of lactose occurs when a baby’s digestive system is unable to produce sufficient quantities of the digestive enzyme lactase to break down all of the lactose.  Silvia was not getting enough of the more fatty hind milk and she was getting too much of the less fatty fore milk. Giving her more hind milk was all that was needed.  The hind milk passes through the digestive system more slowly, allowing time for all the lactose to be broken down.

Silvia’s symptoms started when she was around two weeks old:
- Lots of inconsolable crying for long periods due to pain where nothing would help, apart from a homeopathic remedy that took the edge off but did not prevent or cure the problem.
- Very frequent loose, at times frothy, acidic and watery, bowel movements.  Within a week of increasing the hind milk, she went from 6+ loose poos a day to only having one poo every 4 - 11 days.
- Lots of wind and rumbling stomach.
- Stomach cramps, with her legs pulled up and also stretching out rigidly with arched back.
- Disturbed sleep.  She was in pain when lying on her back and more comfortable upright.

Around week six, after getting the positive lactose lab test, I made the following changes to increase the proportion of hind milk:
- Spread feeds to leave around 3 hours between feeds, from the start of one feed to the start of the next feed, giving full feeds and avoiding snacking on fore milk.
- Built up the feeds from the right breast, as Silvia was mainly feeding from the left breast. The left preference had led to an oversupply of milk in the left breast.
- Expressed 5-50 ml, dependent on which breast and the time of day, before starting each feed.  Within two weeks I could stop expressing before a feed.
- Emptied one breast fully, usually only feeding from one breast. She could not empty the left breast in a feed, so I would express more off the left breast to get to the fatty hind milk.
- Gave lactose free formula for the 2 am feed at night, when my milk was the least fatty.  I returned to breastfeeding at 2 am after about two weeks.

The results were immediate.  Within 24 hours Silvia’s pain had reduced by about 50%, within 48 hours by 80% and within a week Silvia came right.

My experience is breastfeeding.  For breastfeeding mums it is not necessary to wean or switch to lactose free formula, though I used lactose free formula for one feed a day for a limited period.  Lactose overdose is different from a milk allergy, and there is no need for changes to the diet.  Formula fed babies can also suffer from lactose overdose from overfeeding and feeding too frequently.  The key is to change the way of feeding, though lactose free formula can help initial recovery.

Healthy, thriving breastfed babies can experience some degree of lactose overload in the early months of life due to fore milk – hind milk imbalance.  This generally occurs when a mother has an oversupply of breast milk, feeds the baby too often or switches sides too soon.  As a result the baby receives large volumes of low fat fore milk that is disproportionate to the amount of fatty hind milk.

Hopefully sharing my experience and this information on lactose overdose will help others with “colic symptoms”.  I am concerned that none of the health professionals were able to diagnose or provide information on “lactose overdose”, or suggest that I increase the hind milk intake.  Talking with other mums, it seems likely that other “colic” babies could suffer from lactose overload, which in my experience can be easily fixed. 


This story has previously been published in Kiwiparent magazine