need some help for my sister/nephew with breastfeeding issues

My nephew is now 5 weeks old. He has been breastfed from birth. Since birth, he has been in an incredible amount of pain after each feed. He will scream for hours, vomit, get the runs and scream some more. He seems to be wanting to feed every hour.
My sister is an absolute wreck at the moment. She's at breaking point as she doesn't know what to do anymore. She called me yesterday afternoon in tears as she gave him a bottle to see what difference it made, and he slept, had no pain, didn't vomit or didn't get the runs. She has spoken with 3 different LC from Aust Breastfeeding Assoc who unfortunately have been absolutely no help at all. One lady yesterday was so rude to her she got her into tears. She really doesn't want to ring them back. To me, it sounds like an intolerance issue of some sort, but I don't have any experience at all with this. Who would she be best to see with this? LC, Dr, Paed? She would love to keep breastfeeding, but she's not sure that she can mentally. She really is at her lowest point.

I would suggest a pead as they can hopefully make other suggestions if it is an intolerance to breastmilk.

There is a 24 hour info line where they have Maternal Child Health Nurse who might be able to help. It could be colic or reflux issues. 13 22 29

I'm trying to work out what's affecting my bub s tummy who is a similar age and has similar symptoms. things i ave tried and had some success with are feeding lying down (to slow the flow), sitting bub up after feeding, spending lots of time rubbing back changing positions to help get gas out. Also "Infant's Friend" from the chemist- a liquid you give with each feed has helped to reduce the screaming.

Does your sister have a local maternal child health service she can see?

ETA- A dummy can also help if it is colic because the bub is sucking at the breast because the action helps them feel better, but they can be getting too much milk- which then upsets their tummy more.

Thanks for that number Kate, I'll pass it on to her. I know she has tried the Infants Friend, and didn't work :( As for a local maternal child health service, I'm not too sure that she's been to one yet. I know that there would be one around her. I'll suss it out.
black_rose - thanks for that. She has made an app with a Paed for the end of the week. Fingers crossed they can get to the bottom of this.

I hope she can get answers, it's heartbreaking when they are so miserable.

It's important that he empties one boob (even if it takes him several tries over a couple of hours) before he gets the next one.
Was the bottle EBM or formula? Trying an EBM bottle would perhaps split issues due to chemistry/intolerances from issues due to way-of-eating.
If he is gaining weight happily then he's getting enough milk - if not then hunger may be part of it, and measures to increase milk supplly may need to be considered.

Feeding with him more upright may also help - it may be that this was easier to do with a bottle...But it is possible to do with bf as well (generally a football-style hold with bub on a slope).

Have pm'ed you
Not sure if im allowed to post links?

I agree with what Kmn said about emptying one boob before going on to the next one.

From what you describe, it sounds like it could be an intolerance issue, or, if he hasn't dained the boob, a case of not getting enough of the fatty breastmilk (the first bit of BM that comes out is like a drink, then it gets creamier - it could take a young bub several minutes to get this "drink" before getting the "meal").

As for someone to talk to - a GP could hame a recommendation, as it may be an issue to do with mum rather than bub (you're saying the bottle worked, so it could be something the mother is eating, something on her skin, etc - a GP could have a look and them refer them on to the necessary people).

On a final note - what an absolute shame that the ABA lady was so rude. I know that ABA counsellors go through rigorous training to ensure that they are caring and professional at all times, but as with every organisation, there a few bad ones that ruin it for all. If you remember the name of this counsellor, I recommend that you repot her to the ABA head office, as she either needs more training or sholdn't be taking calls at all.

Hi Jodi, not all LCs are equal! And if she has spoken to the counsellors on the ABA helpline, they are actually just bfing counsellors, not qualified LCs. Find an IBCLC qualified LC who is close to your sister https://www.bellybelly.com.au/forums...dations-2.html. She would probably benefit from someone actually visiting her in her home and going through everything with her face-to-face. Runny poos are completely normal in a bf baby so are not a problem in themselves. Vomitting is usually because baby has a weak valve at the top of his stomach (which is very common in babies and usually resolves itself eventually).

Has she tried wearing him in a sling or carrier - sometimes keeping bub close and upright helps settle them after a feed.

Thanks again everyone! I'm passing all of this onto my sis for her to read and take in.
kmn - the bottle was formula. She gave him a couple of bottles last night and he was really settled, first time ever, so she is pretty sure it's something in her diet.
jennifer - thank you so much for that link! I've emailed that to my sis as well. I'm really hoping she'll follow through with it. She's getting so tired now, and I worry she's going to give up too soon.
Thanks everyone! You've all been such a great help.

Some of the smptoms you describe are characteristic of oversupply - bub gets a lot of higher-lactose milk, which he finds hard to digest. Feeding from one side for a couple of feeds until it is empty and then swapping usually deals with this. Sometimes the oversupply comes with the fire-hose let-down, which can frighten bubs - so hand-expressing until the splurting settles and then feeding can help there, as can feeding with her lying on her side and bub lying on a towel on his side, so the milk-gush doesn't "choke" him. Crucially for your sister, these two things settle themselves as bub gets bigger and supply self-regulates - probably in the next few weeks.

If it is "something in her diet", some of the more likely irritants are:
caffeine
cabbage/broccoli/etc
onions

It's not cows milk protein ('cause there's heaps of that in formula)

I actually suspect that the issue is positional/air-gulping/not liking to be horizontal when feeding. I would be really interested to see what the effect of an EBM bottle was!

There is also a small possibility that bub is simply hungry. To check this, offer a little formula bottle after a breastfeed and see if the result is a happier bub. If that is the case then the simplest answer is a day or two of very frequent feeding to up supply.


And: how to deflate a baby - bath (even at 4am if you have to), putting him on his tummy on your chest or tummy, bicycling legs, rubbing tummy in circular way, going outside (it may relax the baby - i always found it relaxed me!)...

Jodi- i read your first post to my DH who reminded me that when we started the Infant's Friend, it took 24 hours of using it before we really noticed the benefits. the mchn said that it is because the wind in the lower gut that is causing the pain/discomfort came from the milk drunk the day before.

if your sister tried it for less than a day or 2 it might be worth trying for longer.

hugs to her, it's hard when you don't know how to makle them feel comfortable. (i'm about to try a bath for my little one)

Jody, the poor mum must be exhausted :hug: I am sorry she hasn't found anyone to help her. It is hard to know without asking some questions, but it could be lactose overload. This is common with oversupply and what you have described fits. The good news is that it usually eases after the early weeks, and there are some things that can be done to manage it in the meantime, like spacing feeds, or block feeding (feeding from the same side for 3 hours or so before swapping sides). There is some really good information about it in the lactose intolerance article here - Australian Breastfeeding Association - Lactose intolerance and the breastfed baby.

I wish her all the very best with getting through this difficult time :hug: