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adding rice cereal

Posted by on Aug. 21, 2013 at 6:31 PM
  • 21 Replies
My ds just had his 4 month appointment. His pedi said we could start giving him a little rice cereal and it should help with his spitting up (he spits up a lot but he is gaining enough weight obviously). Ds is off the charts with his height and weight. He is 17 lbs 10.5oz and 26 inches. I started cereal with dd at almost 6 months. Im just not sure about starting solids yet. But everyone keeps pushes me to start. Dh, my dad, my mom, his parents and grandparents.
by on Aug. 21, 2013 at 6:31 PM
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gdiamante
by Group Mod - Gina on Aug. 21, 2013 at 6:34 PM

Rice cereal is not needed at all. There's another thread about it here.

With the gain you report, it sounds like you've got oversupply/overactive letdown. Check this out:

Forceful Let-down (Milk Ejection Reflex) & Oversupply

AUGUST 20, 2011. Posted in: SUPPLY WORRIES

By Kelly Bonyata, BS, IBCLC

 Is forceful let-down the problem?

Does your baby do any of these things?

  • Gag, choke, strangle, gulp, gasp, cough while nursing as though the milk is coming too fast
  • Pull off the breast often while nursing
  • Clamp down on the nipple at let-down to slow the flow of milk
  • Make a clicking sound when nursing
  • Spit up very often and/or tend to be very gassy
  • Periodically refuse to nurse
  • Dislike comfort nursing in general

If some of this sounds familiar to you, you probably have a forceful let-down. This is often associated with too much milk (oversupply). Some mothers notice that the problems with fast letdown or oversupply don’t start until 3-6 weeks of age. Forceful let-down runs the gamut from a minor inconvenience to a major problem, depending upon how severe it is and how it affects the nursing relationship.

What can I do about it?

There are essentially two ways you can go about remedying a forceful let-down: (1) help baby deal with the fast flow and (2) take measures to adjust your milk supply down to baby’s needs. Since forceful let-down is generally a byproduct of oversupply, most moms will be working on both of these things. It may take a couple of weeks to see results from interventions for oversupply, so try to be patient and keep working on it.

Help baby deal with the fast milk flow

  • Position baby so that she is nursing “uphill” in relation to mom’s breast, where gravity is working againstthe flow of milk. The most effective positions are those where baby’s head and throat are above the level of your nipple. Some nursing positions to try:
    • Cradle hold, but with mom leaning back (a recliner or lots of pillows helps)
    • Football hold, but with mom leaning back
    • Elevated football hold – like the football hold, but baby is sitting up and facing mom to nurse instead of lying down (good for nursing in public).
    • Side lying position – this allows baby to dribble the extra milk out of her mouth when it’s coming too fast
    • Australian position (mom is “down under”, aka posture feeding) – in this position, mom is lying on her back and baby is on top (facing down), tummy to tummy with mom. Avoid using this positioning frequently, as it may lead to plugged ducts.
  • Burp baby frequently if she is swallowing a lot of air.
  • Nurse more frequently. This will reduce the amount of milk that accumulates between feedings, so feedings are more manageable for baby.
  • Nurse when baby is sleepy and relaxed. Baby will suck more gently at this time, and the milk flow will be slower.
  • Wait until let-down occurs, then take baby off the breast while at the same time catching the milk in a towel or cloth diaper. Once the flow slows, you can put your baby back to the breast.
  • Pump or hand express until the flow of milk slows down, and then put baby to the breast. Use this only if nothing else is working, as it stimulates additional milk production. If you do this, try to express a little less milk each time until you are no longer expressing before nursing.

Adjust your supply to better match baby’s needs

  • If baby is gaining weight well, then having baby nurse from only one breast per feeding can be helpful.
  • If baby finishes nursing on the first side and wants to continue nursing, just put baby back onto the first side.
  • If the second side becomes uncomfortable, express a little milk until you’re more comfortable and then use cool compresses – aim for expressing less milk each time until you are comfortable without expressing milk.
  • Avoid extra breast stimulation, for example, unnecessary pumping, running the shower on your breasts for a long time or wearing breast shells.
  • Between feedings, try applying cool compresses to the breast (on for 30 minutes, off for at least an hour). This can discourage blood flow and milk production.
  • If nursing one side per feeding is not working after a week or so, try keeping baby to one side for a certain period of time before switching sides. This is called block nursing.
  • Start with 2-3 hours and increase in half-hour increments if needed.
  • Do not restrict nursing at all, but any time that baby needs to nurse simply keep putting baby back to the same side during that time period.
  • If the second side becomes uncomfortable, express a little milk until you’re more comfortable and then use cool compresses – aim for expressing less milk each time until you are comfortable without expressing milk.
  • In more extreme cases, mom may need to experiment a bit with time periods over 4 hours to find the amount of time per breast that works best.
  • Additional measures that should only be used for extreme cases of oversupply includecabbage leaf compresses and herbs.

Even if these measures do not completely solve the problem, many moms find that their abundant supply and fast let-down will subside, at least to some extent, by about 12 weeks (give or take a bit). At this point, hormonal changes occur that make milk supply more stable and more in line with the amount of milk that baby needs.

Sometimes babies of moms with oversupply or fast let-down get very used to the fast flow and object when it normally slows somewhere between 3 weeks to 3 months. Even though your let-down may not be truly slow, it can still seem that way to baby. See Let-down Reflex: Too Slow?for tips.

 

 Additional Information

Too Much Milk? by Becky Flora, IBCLC

Oversupply by Kathy Kuhn, IBCLC

Tips for taming a monster milk supply by Kathy Kuhn, IBCLC

Gaining, Gulping, and Grimacing? by Diane Wiessinger, MS, IBCLC

Oversupply: Too Much Milk by Anne Smith, IBCLC

Colic in the Breastfed Baby by Jack Newman MD, FRCPC

Am I making too much milk? from La Leche League International

Fighting the Battle Against Oversupply  by Vanessa Manz

Finish the First Breast First by Melissa Vickers (LEAVEN, September-October 1995, p. 69-71)

Overactive Let-Down: Consequences and Treatments by Mary Jozwiak (from LEAVEN, September-October 1995, pp. 71-72)

Common Side Effects of an Overactive Let-Down by Mary Jozwiak (from LEAVEN, September-October 1995, p. 69)

Too Much of a Good Thing by Kate Drzycimski, from New Beginnings Vol. 19 No. 9, July-August 2002, p. 129.

PDF Resolution of Lactose Intolerance and “Colic” in Breastfed Babies by Robyn Noble & Anne Bovey, presented at the ALCA Vic (Melbourne) Conference on the 1st November, 1997

Char06
by on Aug. 21, 2013 at 6:36 PM

I never start any kind of solid until at least 6 months, and I wait even longer for the cereals. 

LilliesValley
by on Aug. 21, 2013 at 6:40 PM

Not sure why. Rice cereal has hardly any nutritional value. I wouldn't start anything this early, especially if the height and weight are fine. Seems really unnecessary and I'd wait a while before introducing solids. I would also really wonder about the pediatrician saying to start that too? They know your bf so do they not know the benefits? do they not know how not great rice cereal and the like are? the only person on that list I'd worry about pushing the solids is your dh. There's no reason to give solids at 4 months.

K-Chan
by on Aug. 21, 2013 at 6:41 PM
He normally nurses while.laying down in bed (he hates nursing any other way) i burp him a lot, he only nurses off of one side.(he has since he was a week old) I looked into forceful let down before.
gdiamante
by Group Mod - Gina on Aug. 21, 2013 at 6:45 PM

If he's gaining, spitup is merely a laundry problem. And that's easier to deal with than potential problems from early introduction of solids. Another thing to check out:

Why Delay Solids?

AUGUST 2, 2011. Posted in: OLDER INFANT,SOLID FOODS

Health experts and breastfeeding experts agree that it’s best to wait until your baby is around six months old before offering solid foods. There has been a large amount of research on this in the recent past, and most health organizations have updated their recommendations to agree with current research. Unfortunately, many health care providers are not up to date in what they’re telling parents, and many, many books are not up to date.

The following organizations recommend that all babies be exclusively breastfed (no cereal, juice or any other foods) for the first 6 months of life (not the first 4-6 months):

Most babies will become developmentally and physiologically ready to eat solids by 6-9 months of age. For some babies, delaying solids longer than six months can be a good thing; for example, some doctors may recommend delaying solids for 12 months if there is a family history of allergies.

Reasons for delaying solids

Although some of the reasons listed here assume that your baby is breastfed or fed breastmilk only, experts recommend that solids be delayed for formula fed babies also.

  • Delaying solids gives baby greater protection from illness.
    Although babies continue to receive many immunities from breastmilk for as long as they nurse, the greatest immunity occurs while a baby is exclusively breastfed. Breastmilk contains50+ known immune factors, and probably many more that are still unknown. One study has shown that babies who were exclusively breastfed for 4+ months had 40% fewer ear infections than breastfed babies whose diets were supplemented with other foods. The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for at least 15 weeks and no solid foods are introduced during this time. (Wilson, 1998) Many other studies have also linked the degree of exclusivity of breastfeeding to enhanced health benefits (see Immune factors in human milk).
  • Delaying solids gives baby’s digestive system time to mature. 
    If solids are started before a baby’s system is ready to handle them, they are poorly digested and may cause unpleasant reactions (digestive upset, gas, constipation, etc.). Protein digestion is incomplete in infancy. Gastric acid and pepsin are secreted at birth and increase toward adult values over the following 3 to 4 months. The pancreatic enzyme amylase does not reach adequate levels for digestion of starches until around 6 months, and carbohydrate enzymes such as maltase, isomaltase, and sucrase do not reach adult levels until around 7 months. Young infants also have low levels of lipase and bile salts, so fat digestion does not reach adult levels until 6-9 months.
  • Delaying solids decreases the risk of food allergies. 
    It is well documented that prolonged exclusive breastfeeding results in a lower incidence of food allergies (see Allergy References). From birth until somewhere between four and six months of age, babies possess what is often referred to as an “open gut.” This means that the spaces between the cells of the small intestines will readily allow intact macromolecules, including whole proteins and pathogens, to pass directly into the bloodstream.This is great for your breastfed baby as it allows beneficial antibodies in breastmilk to pass more directly into baby’s bloodstream, but it also means that large proteins fromother foods (which may predispose baby to allergies) and disease-causing pathogens can pass right through, too. During baby’s first 4-6 months, while the gut is still “open,” antibodies (sIgA) from breastmilk coat baby’s digestive tract and provide passive immunity, reducing the likelihood of illness and allergic reactions before gut closure occurs. Baby starts producing these antibodies on his own at around 6 months, and gut closure should have occurred by this time also. See How Breast Milk Protects Newborns and The Case for the Virgin Gut for more on this subject.
  • Delaying solids helps to protect baby from iron-deficiency anemia.
    The introduction of iron supplements and iron-fortified foods, particularly during the first six months, reduces the efficiency of baby’s iron absorption. Healthy, full-term infants who are breastfed exclusively for periods of 6-9 months have been shown to maintain normal hemoglobin values and normal iron stores. In one study (Pisacane, 1995), the researchers concluded that babies who were exclusively breastfed for 7 months (and were not give iron supplements or iron-fortified cereals) had significantly higher hemoglobin levels at one year than breastfed babies who received solid foods earlier than seven months. The researchers found no cases of anemia within the first year in babies breastfed exclusively for seven months and concluded that breastfeeding exclusively for seven months reduces the risk of anemia. See Is Iron-Supplementation Necessary? for more information.
  • Delaying solids helps to protect baby from future obesity.
    The early introduction of solids is associated with increased body fat and weight in childhood. (for example, see Wilson 1998von Kries 1999Kalies 2005)
  • Delaying solids helps mom to maintain her milk supply. 
    Studies have shown that for a young baby solids replace milk in a baby’s diet – they do not add to baby’s total intake. The more solids that baby eats, the less milk he takes from mom, and less milk taken from mom means less milk production. Babies who eat lots of solids or who start solids early tend to wean prematurely.
  • Delaying solids helps to space babies.
    Breastfeeding is most effective in preventing pregnancy when your baby is exclusively breastfed and all of his nutritional and sucking needs are satisfied at the breast.
  • Delaying solids makes starting solids easier. 
    Babies who start solids later can feed themselves and are not as likely to have allergic reactions to foods.
K-Chan
by on Aug. 21, 2013 at 6:46 PM
The reason why dh keeps saying it is because everytime we eat ds keeps opening his mouth and fussing at us. He gets upset everytime we eat. He is a very calm baby and only cries when he is hungry or needing a change.

Quoting LilliesValley:

Not sure why. Rice cereal has hardly any nutritional value. I wouldn't start anything this early, especially if the height and weight are fine. Seems really unnecessary and I'd wait a while before introducing solids. I would also really wonder about the pediatrician saying to start that too? They know your bf so do they not know the benefits? do they not know how not great rice cereal and the like are? the only person on that list I'd worry about pushing the solids is your dh. There's no reason to give solids at 4 months.

tabi_cat1023
by Group Mod - Tabitha on Aug. 21, 2013 at 6:54 PM
2 moms liked this

YOu can put your LO in a high chair, give breastmilk slushies or a mesh feeder with BM ice cubes.  ALso you can give spoons and bowls to play with. 4 month old is not internally ready for solids, but they also need to be able to sit up unassisted, have a pincher grasp and no tongue thrust either.

asaffell
by Bronze Member on Aug. 21, 2013 at 7:01 PM

I was reading that Jack Newman said spitting up is actually GOOD for breastfed babies because it pushes those immune cells into the lining of the nose and throat again for absorption. 

MusherMaggie
by Platinum Member on Aug. 21, 2013 at 7:22 PM
Look up baby-led solids. Spitting up is normal. He is merely imitating you when he watches you eat. Babies don't need to be spoon fed, ever. Children imitate driving cars, too-certainly does not mean they're ready for the real thing!
jmaw89
by Bronze Member on Aug. 21, 2013 at 7:27 PM
I too would skip the cereal and wait on any other solids :)
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