Question about hunger cues and gas

[BethG]

My son is six weeks old today. I am having trouble reading his hunger cues to know when he is "demanding" a feeding. We do better during the overnight - usually when he wakes up and starts to fuss, it's to eat, but during the daytime, especially if he's been awake, it's hard to tell and we end up in a cycle of a few minutes on the breast, screaming (I should add I have a forceful letdown) and then off for an hour or so, never getting in a good, long feeding. I've read the hunger cues on kellymom.com but I find them inconclusive. He'll fidget, squirm, breathe heavily, but then when I put him on to feed he'll freak out crying. He was gaining a lot of weight between weeks 0-4 but only gained 8 ounces in the last two weeks. Any better suggestions on understanding the demand for food before complete crying?

The other problem we have is sometimes he will lose it during a feeding because of gas. I can tell he's still hungry but is so distracted/pained he can't eat. Besides changing my diet and waiting it out, any other things we can do to keep him on during a feeding?

[Sharon_Mattes]

Dear mom of 6 weeks old:

Your frustration is understandable - and yours is certainly a common concern.

My guess is that you have considered that this could be a time that he goes
through a 'growth spurt' and just wants to feed often (every hour or so). If
this is the case - it can be several days before he settles down and is full for
a longer time. Also - if baby goes 3 hours or more during the day - you can
expect him to feed more frequently during the night - as he needs a certain
number of feedings in 24 hours - just for calories and sucking need. Then, of
course there are those "I want you mommy - I want to be held, etc." times.

Since you say you recognize there are more reasons to nurse a baby than for hunger - perhaps it would make you feel better if you just don't worry whether this nursing time is for a 'feeding' or a 'nurturing' and when in doubt -
if he fusses and you aren't sure - just feed him.

A baby who is screaming 'while at the breast' is not feeding. He is unhappy for a reason. You probably hit the nail on the head when you mentioned your rapid letdown - as this typically can cause baby to take in too much milk at
one time - causing him to swallow air and have gas pains. Babies all seem to
interpret any tummy distress by 'acting hungry'...but that doesn't always mean he needs to eat. Sometimes it is gas - sometimes it is overfullness -and sometimes it is hunger.

You don't say if you offer one or both breasts - but with a very active milk
ejection reflex - it is helpful to do two things. 1) use a lying down or laying
back position for feedings. (recliner - pillows reclining on sofa - bed) and,
2) offer only one breast per feeding . If he seems hungry in another hour,
first try the softer or less full breast. You will know from his reaction if he
just wants to nurse - or is still very hungry. If hungry, he'll object to being
put on the emptier side.

If he seems uncomfortable (pulls away - wriggles - cries) after only a few
minutes at breast - take him off - burp him - walk around - talk to him -
to see if he is uncomfortable from air swallowing. When he seems better,
offer that breast again to see if he can comfortably feed.

If he pulls away and cries after it is obvious that he has been swallowing
for 4-5 minutes - it is very possible that he is full - with your letdown
delivering his 'meal' extremely quickly. He may still need sucking - but
does not want more MILK. You don't say if you have tried your finger or
a pacifier after you feel certain he has fed well. We don't usually recommend
pacifier use this early - however if you are giving him several ounces in a very
short time - and he is full to discomfort but still unsettled - perhaps he needs
other soothing methods like pacifier, swaddling, rocking, etc.

My next suggestion would be to do a weight check for one feeding. You can
make an appointment with your Pediatrician or a Lactation Consultant -
just for a wt ck. You weight the baby in only a clean diaper...then feed
him --- then weigh him in that same clean diaper (don't change it) after -
and you can see if he is taking enough milk in such a short time.

I have seen many mothers in my office, who think baby is not getting enough
milk - who are shocked to see that their baby (7-8 lbs) can take in 4 ounces
in only 5 minutes! They are full - but ate so quickly they don't feel settled.

A baby should be taking in 2.5 X his body weight daily which for an 8 lb baby would be 20 oz. a day. When he feeds 9-10 times he takes about 2.5 - 3
ounces per feeding. Of course a baby who is older may begin to take more at
a feeding but less often - and go a bit longer at night as well.
During a growth spurt (3 & 6 weeks - 3 & 6 months) he may need 3 X his weight daily so that is the reason he will feed more often for a few days.


Try not to assume your baby will be happy with - or need "a good, long
feeding". As they get older, babies get more efficient. However, they
still need your holding, comfort, love, suckling and interaction...so it doesn't
actually give you any longer a break when the feeding is shorter. :)

His weight gain should be about 1-2 lbs per month - but it can vary and be normal. Your pediatrician can look at his growth curve and tell you if he is within the typical range.

Keeping a baby at the breast when he is obviously through isn't going to be
a helpful idea. Learn to look at his cues - listen to what he tells you. YOu
might enjoy attending a La Leche League meeting - where there are other
babies his age so you can get an idea of what others find to be 'normal'.

Hope I have helped.
Sharon








__________________________________________________ ____________

My son is six weeks old today. I am having trouble reading his hunger cues to know when he is "demanding" a feeding. We do better during the overnight - usually when he wakes up and starts to fuss, it's to eat, but during the daytime, especially if he's been awake, it's hard to tell and we end up in a cycle of a few minutes on the breast, screaming (I should add I have a forceful letdown) and then off for an hour or so, never getting in a good, long feeding. I've read the hunger cues on kellymom.com but I find them inconclusive. He'll fidget, squirm, breathe heavily, but then when I put him on to feed he'll freak out crying. He was gaining a lot of weight between weeks 0-4 but only gained 8 ounces in the last two weeks. Any better suggestions on understanding the demand for food before complete crying?

The other problem we have is sometimes he will lose it during a feeding because of gas. I can tell he's still hungry but is so distracted/pained he can't eat. Besides changing my diet and waiting it out, any other things we can do to keep him on during a feeding?

[BethG]

Sharon,

Thanks for your detailed response. I give him one breast per feeding and try to stick with the same breast if I feed him more than once in a two hour period. I offer him the breast at any questionable sign of hunger since he has latch on issues I don't want to wait for him to be frantic or he'll have a really hard time. We had a lactation consultant here when he was 2 1/2 weeks old. He ingested 56 grams of milk (a lot) in the first five minutes and 50 in the second five, so I know he's a fast feeder. I can tell by his sucking and sound of milk flow whether he's pigging out or not. I don't expect him to be on the breast more than 10 minutes unless they are very empty and he's working harder to get milk to let down. He's not a comfort nurser at all because of the forceful letdown (I have accidentally squirted milk all over his face). He would much prefer to suck on a finger than comfort nurse. He's rejected the pacifier too. We are doing cross cradle hold because of latch on issues (original reason we had lactation consultant). I haven't had much luck with side lying, and when he is really hungry, in the nighttime, he doesn't seem to mind the forceful letdown - can finish his business sooner and go back to sleep. I can always tell when he's satisified because he closes his eyes and crosses his arms and acts very contented. On those feedings I know to stop. It's the ones where he's kicking his legs all over the place that I have more concern about, when they are short and I don't hear a ton of swallowing. I also concerned that he will start associating the breast with stress after all the difficult feedings we've had. Are we doing him a disservice with too much finger sucking? Can he be doing that when he's really hungry and then not eat?

[Sharon_Mattes]

Dear Beth:

Sounds like you are doing a great job working to figure out this baby! :)

You see he enjoys feeding only for food - so he is content to feed rapidly and then suck
his fingers. (or yours) That is not a problem. Some babies manage their normal sucking
needs this way. And yes, he could be sucking his fingers and not be hungry.
He may sometimes want to suck but not to have food. Listen to him in this.

You may not hear as much swallowing now if your supply has closely matched his need.
You might have had too much milk in the earlier weeks and now have just about the amount that he needs for each feeding. Most moms make just a little more than baby
requires.

If you are forcing him to stay on the breast when he shows you he doesn't, I can see that being a problem for him associating with an uncomfortable situation. However, if he feeds when he needs to and only as long as he wants - and he gets burped well and can be comfortable - I don't see that causing a negative association.

If you offer food and he refuses - it usually means he isn't hungry and is trying to meet another need (which you may have to work to discover!) :)
Sharon