Ep 2: OAL, Reflux, Food Allergies

Spit up, choking at the breast, constant fussiness, green stools, arching, gas... OH MY! Is it overactive letdown, reflux, or a food allergy? In this episode we break down how all 3 of these issues can look shockingly similar in babies, and why so many parents end up overwhelmed trying to figure it all out. We'll talk through similarities, differences, common overlaps, and how to determine what's really going on.

We will also bust some myths and answer listener questions from Madisyn and Erika!

Send us your questions!

Email: thefeedinghotline@gmail.com

Voicemail: https://www.speakpipe.com/TheFeedingHotline

Transcript

SPEAKER_03 0:02

Welcome to the Feeding Hotline where we answer your real questions about feeding your baby. Breastfeeding, pumping, bottles, solids, all of it. Hey, I'm Kathy. And I'm Tess.

SPEAKER_00 0:12

And we are here today to talk about an incredibly big subject. And it's a big subject because it's three different subjects in one. And I'll tell you, for me, the driver is I get about two or three videos a week sent to me of baby screaming. And I don't like it. It makes me sad. So we because we live that, we just kind of want to work through that today. So we're going to look at reflux, lactose overload, and food allergies. Yes.

SPEAKER_03 0:40

That's our topic. And how they all can sometimes mimic each other. Yeah. I like to tell parents often if there were a Venn diagram of the three symptoms, it would be almost a circle. And so it can be really hard to figure out what's going on with your baby, especially when you get into the interwebs and start Googling. Right. And then you're just kind of guessing. Right. So we're we're hopefully with this topic going to take a little bit of guesswork out of their hands.

SPEAKER_00 1:15

And the really cool thing about the discussion we're having today is everything we're going to suggest is free. That's free treatment. Right. If one thing doesn't work, the next thing we're going to try may, and it is sleuthing work.

SPEAKER_03 1:30

It is sleuthing. That's, I think, why I love this work so much, is there's so much investigative work that goes into it.

SPEAKER_00 1:39

Yeah. And you got to dig a little. And it's every day. It is. And you can't get complacent because that one little child. And I think the other thing we should probably say, and we kind of jumped into all this, but all three of these things reflux, lactose overload for baby's gut, which usually comes with mom having really rapid letdown and overactive letdown, um, and food allergy, uh, they look very much the same. Right. And babies can have more than one of them.

SPEAKER_03 2:08

Right. All right. So before we dive into the topic, I just want to ask you how your week has been.

SPEAKER_00 2:28

It has been awesome and crazy busy.

SPEAKER_03 2:31

Yeah. How many patients have you had so far?

SPEAKER_00 2:33

Well, it's only Wednesday, by the way. It really is, you know, I've been full of patients. However, we're, as you know, the business, we're navigating this insurance nightmare in America. Yep. And it's never ending. So it's about a 24-hour a day. Is this working? Is this not working? And that is not the field I planned on being in. I know.

SPEAKER_03 2:55

Yeah.

SPEAKER_00 2:55

Quite the opposite. What I went to school for. I don't enjoy it.

SPEAKER_03 2:59

I don't know who does, but I'm thankful that you're doing it. Oh. Because it is all way over my head.

SPEAKER_00 3:04

Oh my gosh.

SPEAKER_03 3:05

But obviously, I don't think you feel like you have a choice. It's like your business.

SPEAKER_00 3:09

We don't really have a choice. And we want our patients, whenever possible, to have insurance coverage, right? That's a great benefit when you have it. Um, but yeah, even though we're a really busy business, lactation-wise, we're still a small business. Yeah. So we don't have deep, deep pockets, right? To keep hiring people to do A, B, and C. So guess who does it? It's the owner and her husband, Jeff. I have to give him a shout out, who do the insurance. You know, work through that insurance problem solving. Yeah. Um, and it's a lot. So anyway, yes, I love seeing my mamas and babies, and insurance is a necessary uh problem right now. So we're navigating.

SPEAKER_03 3:52

Yeah. Well, trying to anyway. What about you? Week's been good. Thankfully, since you've navigated some of the insurance stuff, I've been busier. Yeah. Which I I like.

SPEAKER_04 4:03

Yeah.

SPEAKER_03 4:04

Um, I'm not good sitting idle, although I do find ways to keep myself busy. One thing I do struggle with is the flip-flop of busy versus not. But anyway, weeks going well. I've been looking forward to this.

SPEAKER_00 4:22

Oh, me too. I'm excited about it. Me too. Because I feel like we're in houses all the time, but you're teaching this information a day to one person at a time. Yeah. And it truly impacts so many people. They don't even know. Moms don't even know what they're dealing with. I case in point, I had a mom yesterday I ended my day with, and she was right in the thick of this. And she had been dealing with it again for over two months and did not realize months. Yeah. And didn't realize what was going on. Did you tell her we were going to talk about it on Twitter? Yes, I didn't. I said, check out. Yeah, check out our podcast. I even told this is terrible. I even told the baristas at Starbucks on 96th Street. Okay. There are my gals and guys there. But yeah, so it was so funny. But I am excited about this. I really am. Yeah. So we can get the word out, hopefully a little bit more than just the one-on-one. Which I love one-on-ones, but a lot of moms are suffering.

SPEAKER_03 5:19

Yeah. So let's break each down. Lactose overload, which sometimes mom experience OAL, overactive letdown. Let's just let's dig into that a little bit.

SPEAKER_00 5:32

I think that's great. And I think the thing about all of this is every one of these topics could be its own show. Truly. And it may be at some point. But I think it's the overlap that we really need to kind of at least get the basics out on today. So I do want to say this everything we're talking about starts with good gut health. And we now know gut health for baby is flourishing while mom is pregnant. And then what happens afterwards is a huge impact on all three of these things: reflux, lactose overload, and any kind of food allergy. So I think good gut health, meaning is it's hard. Is mom eating a healthy diet, right? Because that can really help with that gut flora for baby. Um, did baby go through something? I know we're kind of getting off on where we want to go, but was there a C-section? Did mom have antibiotics? That can impact mom and baby's gut flora. There are so many things, illness in the family that can impact the health of the gut flora. But a lot of this is going to come back to looking at that.

SPEAKER_03 6:36

Yeah.

SPEAKER_00 6:36

And that's when we're in appointments. That's something, you know, we try to talk about how can we get you on the right road to gut health? And it's nutritional and also um possibly taking a probiotic.

SPEAKER_03 6:48

Yeah. Yeah. So that sets the stage for a healthy mom and baby. But within that, even if everything is perfect, we're still gonna see these issues.

SPEAKER_00 7:01

Right.

SPEAKER_03 7:02

So let's talk about OAL first.

SPEAKER_00 7:04

Okay. So I think there's a lot of confusion as to what that even means, right? So there are some moms that are are blessed, they have a wonderful volume of milk, but it can be, we've talked about Niagara Falls milk production, right? Yeah. Garden hose. Yeah, garden hose. It's so fast, it can overwhelm the baby. Um, mom's thrilled, we're all thrilled. Baby, though, can be really struggling.

SPEAKER_02 7:28

Yeah.

SPEAKER_00 7:28

So this is where it gets kind of confusing, right? There's nothing wrong with mom's milk. It's just if we think as mom is refilling that nighttime when prolactin is the highest, she wakes up in the morning, her breast is incredibly full. And we kind of know that down by the nipple, it is skim milk in the first few feeds of the day. And as the day goes on, it's getting higher in fat, higher in fat, higher in fat. But what happens is the lactose, just sugar, nothing wrong with sugar in this form, right? Nothing wrong with it. It can be so high in lactose. Again, that's not a bad thing, but the bowel can only handle so much. Sure. So then that sweet baby's little bowel is getting overwhelmed with this skimmer. There's not a better way to say it, really. I've read so many studies and look, it's just not a great way. Right, high lactose milk. Yeah. And it's not what the formula companies talk about where lactose is evil and we have to have lactose-free milk. No. It is just simply a fact of mom that has wonderful hormones, wonderful holding tanks, lots of milk ducts, loves that baby, oxytocin screaming, and that milk comes pouring down at that baby, and the baby is taking a lot of milk in that could be higher in fat.

SPEAKER_03 8:52

Yeah. So typically what I see is when I'm like, oh, that's uh a big red flag for lactose overload is a when a mom tells me my baby comes off a lot. They're coughing, they're sputtering. When my baby comes off the breast, I am spraying everywhere. Sometimes I see babies that don't unlatch, they can handle the flow well, but you are clearly hearing them just guzzling. Right. Um, and that for me is one of those first signs where I'm like, we could be dealing with lactose overload.

SPEAKER_00 9:30

Right. And I think they often have explosive stools. You can hear it across the room. And I kind of have this ballpark figure. This is anecdotal, but when we start having 10 or more stools a day, okay, just a ballpark figure I've seen throughout my career. Okay, they often are having belly issues.

SPEAKER_03 9:50

Okay.

SPEAKER_00 9:50

We see the color differences in the stool, and just we're gonna talk a lot about stool color, but green or what I call Dijon mustard and real messy, yeah, often stinky. Okay, that can be allergy and that can be lactose overload.

SPEAKER_03 10:04

Well, let's talk about stinky because anybody might consider regular baby stool stinky. Yeah. So what do you mean when it comes to stinky stool? What are you really smelling?

SPEAKER_00 10:23

Well, we know that most breast milk-fed babies, the stool has what we would say more of a sweet odor to it. Okay, it's identifiable, but it's not to me, if you've ever had a virus, yeah, and your bowel movements stink.

SPEAKER_03 10:37

Yeah.

SPEAKER_00 10:38

They have a very strong odor to them. And it's so I compare it to that. And when parents immediately say to me, Oh my gosh, he had a bowel movement, whoo, that stinks. Yeah, that's usually a pretty indication. There's a gut thing, good indication. There's a gut thing going on there, and it may be lactose overload.

SPEAKER_03 10:57

It's almost a little sour to me.

SPEAKER_00 10:59

It can be a little sour. Yeah, I agree.

SPEAKER_03 11:02

Yeah.

SPEAKER_00 11:03

And those kids are often very fussy kids. They're often um, this is a biggie, and this is hard. And moms, if you hear this, this doesn't apply to every baby.

SPEAKER_02 11:13

Yeah.

SPEAKER_00 11:14

They want to eat all the time. Right. All the time. This was my case yesterday. So gaining like a weed, big weight gain almost always. Sure. They're going go, go, go, go, go, but they act like they're hungry very quickly after the last feeding. Maybe an hour, maybe two. But their weight gain is so large, you're thinking, why in the world would that baby need to eat again that quickly?

SPEAKER_03 11:39

Right. And and the natural thing for many moms, it was for me, when your baby is fussy, you put them to the breast. Right. So let's talk a little bit about why moms with an overactive letdown can do even more disservice to baby when they're doing what unfortunately is the natural thing. My baby's fussy, I put them to the breast.

SPEAKER_04 12:11

Yeah.

SPEAKER_03 12:11

Well, talk about that a little bit and then ways in which you have your patients soothe their baby without putting to the breast.

SPEAKER_00 12:23

So I think we have all been taught that babies will refuse the breast when they're full. Sure. I have three boys. No, my three boys would have nursed 24 hours a day if I put them to the breast.

SPEAKER_03 12:36

I very rarely see a baby who's like, nope, don't want it.

SPEAKER_00 12:38

Yeah. Exactly. And let's be honest again. Part of that, mom's warm toasty, hear the heartbeat. I love my mommy.

SPEAKER_03 12:46

Yeah. You smell her, you see her.

SPEAKER_00 12:50

Exactly right. And I love sucking is soothing. Sucking is soothing. That's what I was just gonna say. Sucking is soothing, and not just sucking is soothing, but when that saliva increases, and I'm gonna say, just like on a pacifier, the saliva increases, that has constituents that help calm the gut, calm the esophagus. So the act of sucking can be healing. Right. The problem is, and we're gonna talk about how we deal with it. Okay, I just took in another two ounces because I'm sucking to comfort. Right. And I already had so much in, my belly's distended, I'm gassy, I feel miserable. But mom did what everybody told her to do: feed the baby, feed with cues, feed the baby, feed with cues. And in this situation, we get into trouble. So there are a lot of different ways to handle it. Number one, um, if we talk about soothing, and again, this is not always popular in our field, but a pacifier, we can talk about palate, we can talk about that all day long, but it can be a medical tool.

unknown 13:54

Yeah.

SPEAKER_00 13:55

So baby's not always on your breast.

SPEAKER_03 13:57

And that can be hard to tell a parent who is so worried about quote nipple confusion. Right. I had him on this week. Her baby is two weeks old, fed from one breast, got five ounces in 12 minutes. Whoa. Okay. Yeah. She's spitting up a lot, but there might be some, we'll get into this next. Um, family history of reflux. Dad has uh lots of GI stuff. So we just had, I had to help reframe the picture a little bit. And I said it the first time, but parents are sleep deprived, they're not gonna hear everything I say. Sure. Offer the passy immediately after a feed. It will help keep contents down, it will help soothe their belly.

SPEAKER_04 14:49

Yes.

SPEAKER_03 14:50

And so the passy can be a great tool. Yeah. For exactly that.

SPEAKER_00 14:54

It can. And what else can you do, right? You've got fussy baby syndrome, they're wanting to suck to calm. Sure, we can rock, we can sing, we can play. We both love getting outside, yeah. Grounding, letting that baby ground, get in the sun, enjoy the ground, be outside. All that's true. And there are times when your baby's still crying, you're like, what the heck am I going to do? I'm pulling my hair out. Yeah. So part of it is for me, I try to explain to moms, if we're on the right journey, this isn't dairy, just this isn't dairy protein. Right. This is not reflux. This is purely lactose overload. If we do just what you talked about, Tess, and I kind of like to remove some of the skim milk, especially in the first few feeds of the day. So we immediately get that baby to the higher fat milk.

SPEAKER_02 15:42

Yeah.

SPEAKER_00 15:42

I kind of focus on about 10 to 15 sprays or about a half an ounce. Baby's not as overwhelmed, so they can enjoy feeding more. Yeah. And then now we're getting to higher fat milk. And I know the fat content changes all day. And I know mom to mom and baby to baby, it varies from all day.

SPEAKER_02 16:00

Right.

SPEAKER_00 16:00

But I found that really helps for the short term. Let's help that baby enjoy breathing while they're eating, get to higher fat. And then here's the big deal. If we do all those things and it's hard for about three to five days, that gut starts to heal.

SPEAKER_03 16:17

Yeah.

SPEAKER_00 16:17

The baby starts to feel better. And now we don't have this quote in quotations colicky acting baby.

SPEAKER_03 16:25

Right. Colic is a throwaway term.

SPEAKER_00 16:28

Right.

SPEAKER_03 16:28

Babies don't cry for no reason.

SPEAKER_00 16:31

Right.

SPEAKER_03 16:31

And that's why it can also be so confusing. And you kind of touched on this where they're just gaining and growing like a weed. Babies can gain just fine off of high lactose milk. That's not the issue. The issue is that high lactose milk can sometimes cause belly upset. That's right. So then getting to that higher fat milk, not because it's going to help the baby gain weight, it just helps soothe the belly a little bit better.

unknown 16:59

Right.

SPEAKER_03 17:00

And we often see moms in that high lactose or lactose overload, early morning feeds, first few fate feeds of the day. I mean, some the uh, you know, unlucky or lucky or whatever, some have it all day. But generally you're saying, rule of thumb, first few feeds of the day, take some off. Right. Whether you're hand expressing, using uh a hand pump, um, this is a time where a haka can be a good tool. Cautiously, cautiously. Cautiously. Yes. Very cautiously. I agree. It is a pump, ladies. It is a pump. Um, but you can take off just enough to get to that higher fat milk. Right. Okay. So many women already know what that looks like. But for the new moms or the moms that really got to tune in, what are they looking for?

SPEAKER_00 17:57

As far as volume?

SPEAKER_03 17:59

No, as far as how do they know they're getting to higher fat milk?

SPEAKER_00 18:03

Well, I don't focus so much on that. If we've identified the behavior in the baby, the colors of the stool, and that's not all kids, but most kids have those issues, often the foul smell, frequent stools, rapid weight gain. I don't focus on the appearance or anything like that with the milk. I focus on a number. Okay. Just simply a half an ounce. We start taking a lot more milk out, and this is anecdotal. We take a lot more milk out than that. We quote, empty, don't love the term, empty the breast. Now, that mother who's already set up for making a boatload of milk is now making enough, again, for the third world nations, which she doesn't need to.

SPEAKER_01 18:39

Yeah.

SPEAKER_00 18:40

Right? So I focus less on the appearance of the milk or anything like that. Okay. Okay, and I want to talk about bottle feeding moms with this too, but I focus less on that and more of we're gonna pick a ballpark figure. We're gonna start with if you tell me your baby's overwhelmed the first few feeds of the day, coughing, choking, arching, we're gonna take a little bit of that off prior to putting the baby on. And this is not forever.

SPEAKER_03 19:04

Right. It shouldn't be forever.

SPEAKER_00 19:05

It shouldn't be forever. And so then the baby can enjoy the feeding. And so it's for me, it's just about 10 to 15 sprays. A lot of women, that's about a half an ounce. Uh-huh. Now, a mom will text me and say, Okay, I think I've got to take more off. Okay. Be careful, be cautious, just take a little bit more off, about another half ounce. Let's just see who you are.

SPEAKER_02 19:24

Yeah.

SPEAKER_00 19:24

It sounds weird, but what starts to happen is we are starting to downregulate. Right. Baby's belly is starting to feel better after two, three days. They're demanding less. So now your volume is regulating anyway.

SPEAKER_03 19:39

Yeah. And that can be a scary thing for moms who used to feel so full all the time. Right. And now they're worried. Oh, do I have enough for my baby? Because they're just so used to feeling full all day.

SPEAKER_00 19:52

All day. And it's terrifying. Yeah, it is. And I've had moms that are just exclusively pumping and bottle feeding, and they are going through the same thing. Why? Because they're pumping and feeding immediately that milk. Nothing wrong with that if your baby's feeling fine, but same scenario, the baby's willing to eat every hour or two.

SPEAKER_01 20:12

Okay.

SPEAKER_00 20:12

Interesting, right? So we with that mom, excuse me, she had storage milk. So we kind of mixed milk up for 24 hours, knowing that then what that baby was getting was in each bottle a little higher fat content. Okay. And I don't want to go crazy with it, right? Usually gentle management that we're talking about, the easy thing. After two or three days, we're seeing improvement. And we don't have to keep controlling all of this forever. Right. Baby's gut starts to mature. It's allowing. We're hopefully allowing it to mature and become healthy because now we're not overwhelming it all the time with lactose. Yeah. So now the gut flora can actually start to flourish. And I'm in favor of probiotics. Not all peds want babies to have probiotics early on. I can't really find a lot of research as to why. Mom can take one, baby gets the benefit, but I think it's a win-win in that situation.

SPEAKER_03 21:06

Yeah.

SPEAKER_00 21:07

So typically with lactose overload, if we stay the course, and this is the hardest thing. It's so easy for us to write a plan and walk out the door. Right. But they have they're the ones that have to follow it. Right. They've got the screaming baby 24 hours a day. And here's the thing I said to this mom, your husband is going to mean well. But he is going to offer you the baby because the baby's rooting like crazy and say you need to feed the baby again. Or grandma's going to say it. Somebody's going to say it. Yeah. And the truth is, you know that baby just ate.

SPEAKER_03 21:36

Yeah.

SPEAKER_00 21:37

So you aren't like every other mom. Yeah. You're not. And that's hard.

SPEAKER_03 21:41

It is hard. It's hard to say to a mom when their natural instinct is to put the baby to the breast when the baby is uncomfortable. You can't do that.

SPEAKER_04 21:50

Right.

SPEAKER_03 21:51

So lots of times, OAL or lactose overload can mimic reflux. We see babies like You said arching at the breast. There's lots of spit-up because they're overfilling the tank. So let's touch a little bit how lactose overload and reflux can mimic each other and then how we suss them out to then separate.

SPEAKER_00 22:20

And I think it's hard. It's really hard because again, babies that have true true reflux can be gaining great. Yes. Gaining like a weed. Yes. But their behavior is what you said. Arching, coming off the breast frequently. Their face is in pain. Well, it is with lactose overloaded too, too. They have that facial grimace. Yeah. They can turn red in the face, not always. They have that high-pitched cry that says, I hurt, right? Yeah. And I think the hard thing with reflux is it can be multifaceted. So it can be vomiting.

SPEAKER_02 22:55

Yeah.

SPEAKER_00 22:55

It can be Niagara Falls. It's all coming out like a fountain. Or it can be where they look like they're swallowing again and again after a feeding and they can't keep that milk down. Yeah. And they stretch their body, they get their head up really, really high, and their body is lengthwise. I often call it, they look like a little straight soldier on the breast where they're straightening out, arms down by the side, as hard as it can be, because they're chronically refluxing. You just don't know it because they may not be throwing up. Um, same thing with nighttime. And babies are noisy anyway, but a lot of these kids are all night long because they're still refluxing, whether they're vomiting or not. Lip smacking. Lip smacking, absolutely. Yeah. But how do you differentiate? Well, a lot of times reflux kids don't have smelly diapers. Okay. They don't have frequent stools. Okay. Now again, this is hard for this whole discussion. They may, mom may have both. She may have um overactive letdown, baby has lactose overload, and baby is truly refluxing. Yeah. And again, this is where we have to be patient. And it may take a week or two to really hone in on, okay, we're past where this should be lactose.

SPEAKER_02 24:09

Yeah.

SPEAKER_00 24:10

I think your baby also has, and here's what this is based on, some reflux.

SPEAKER_02 24:14

Yeah.

SPEAKER_00 24:15

You've done all that you can do, right? So then we look at again the pacifier can help sucking on something, your finger, the pacifier or something for reflux. Yeah. Calming of that esophagus, the gut, um, can help. There are times if we've done probiotics, we've controlled the speed of the flow because we think they also have lactose overload. And we've done everything that we can possibly do. And again, this can take a couple of weeks. There are some kids that were going to need medication. Yeah.

SPEAKER_03 24:47

I also see babes with reflux have short, frequent feeds. And I feel like it's them protecting themselves.

SPEAKER_04 24:56

I agree.

SPEAKER_03 24:57

They know that if they consume more than that, they're going to be in even more pain. And they are smart little beings.

SPEAKER_04 25:06

Yeah.

SPEAKER_03 25:06

So they will eat more frequent, maybe five minutes here, five minutes there, because they know they will feel better.

SPEAKER_04 25:15

Right.

SPEAKER_03 25:15

And that can also mimic the OAL, a baby feeding all the time because they are trying to suck to soothe. So reflux is more seeing it in their physical body rather than, say, hearing it at the breast or those large, frequent, uh, explosive, smelly stools.

SPEAKER_00 25:40

I agree. I think those are really two good ways to differentiate the two if they're not both going on. Right.

SPEAKER_03 25:46

Right.

SPEAKER_00 25:47

Um, and I think also I loved what you said about self-limiting.

SPEAKER_03 25:52

Yeah.

SPEAKER_00 25:52

Right. And we see it with bottle babies. I remember a few years ago, a doctor was a friend texting me going, we got to make this baby take more milk in the bottle. And I've never met the baby, right? Yeah. And the baby was refluxing.

SPEAKER_02 26:05

Yeah.

SPEAKER_00 26:05

It's like, okay, that baby is self-limiting at two ounces. So should should she be taking three or four at a feeding at that age, this baby, that would have been great, right? But I can't force a baby. You can't force a baby to take more. And a lot of times those kids need a swallow study, right? Yeah. And it's it's a dichotomy and different people feel differently. But if we truly don't know, and I get if I get to the point with a mom and a family, I go, I really think your baby is struggling with reflux. Usually it's two different options. There's a swallow study to say, hey, do we really have reflux or is there something else going on? Or a trial of medication. Is it fair to say to a family they will outgrow this at six to nine months?

SPEAKER_03 26:53

I mean, think of the time. Like you said, we write a plan, we leave. The doctors say, hey, it's they're gonna mature out of this every day with a miserable baby. A, the baby deserves to feel good. And B, that's not sustainable.

SPEAKER_01 27:10

Right.

SPEAKER_03 27:11

Parents will go crazy if they are dealing with a baby that is constantly screaming and uncomfortable and has to be held and needs to be upright for this amount of time. So it just doesn't feel sustainable to say, hey, at six to nine months, your baby's gonna outgrow it.

SPEAKER_00 27:32

Right. I agree. And I think it goes back to healthcare in America and the messages we give that are I see you one time and I say, here, go home and triple feed your baby.

SPEAKER_02 27:44

Oh my gosh. Okay, yeah.

SPEAKER_00 27:45

So things we do, maybe to a fault, I put myself in that family's shoes. Maybe to a fault, and I'll say, I could not triple feed for longer than.

SPEAKER_02 27:56

Right.

SPEAKER_00 27:56

I, you know, I cannot put up with a screaming baby 24 hours a day for longer than. Maybe that's true, but I will tell you, most families, if given an option of let's try this plan. Yeah. And our goal is to get you a healthier, happier baby that can enjoy life. And I'm telling you, with food allergies, whole other topic, it may come down to formula. Yeah. I've worked weeks with kids doing elimination diets, ending up with a baby on an amino acid-based formula, and you know what? That gave their family joy. It is not all or nothing black or white. And at the same time, what is a functional plan? So back to what our topic is, right? Yes, could we wait six to nine months and reflux is better? Food allergy is better, lactose overload is better. Our mom and dad or our parents.

SPEAKER_03 28:48

Are they still married? Right? It's just, it's just not fair when people invalidate parents' concerns by saying, just wait it out. It doesn't bring them any comfort. Right. And it also doesn't give them any answers.

SPEAKER_00 29:07

Right. There's no plan. There's no plan. And even there are times I leave a plan, I think, oh my gosh, that was the longest, lengthiest plan. Same. And they'll text, you know, they'll ask questions, but it's like, okay, if this doesn't work, we're going to be. If it doesn't work, we're going to see. And in the middle of this, we're going to be in contact so we can say, this isn't working. This is what I think. Yada yada.

SPEAKER_03 29:29

Yeah.

SPEAKER_00 29:30

Yeah.

SPEAKER_03 29:30

And then, you know, I feel like reflux and OAL mimic each other a lot. And then we throw in food allergy or cow's milk protein allergy. And I feel like CMPA can mimic both OAL and reflux. So let's touch on that. How we try to figure out before we say elimination diet. Because no, I don't want, I never want that to be my first go-to for any family because that's really hard. Um, so how do you personally try to suss out cow's milk protein allergy versus OAL and reflux? What's your what's your typical go-to?

SPEAKER_00 30:15

So we know that, and there is the research on CMPA and food allergies in babies, is exploding.

SPEAKER_02 30:22

Yeah.

SPEAKER_00 30:23

We have learned so much in the last year. So we know that there's about 1% of babies that have CMPA, okay, or a food sensitivity in general, but we know it could present itself in about 50% of kiddos in reflux.

SPEAKER_02 30:37

Yeah.

SPEAKER_00 30:38

So one big tell to me, to set those to the side for a second, if I walk in the house and that baby has a sandpaper, red rash on their face, their upper body, I'm leaning real heavy already towards there is a food sensitivity, and it's almost always dairy, almost always, and parents are not aware of it at all.

SPEAKER_03 31:00

Well, how do you help them see the red sandpapery rash and say, that's not baby acne? Right. It is, these are two different things because I hear all the time that's just baby acne. Right. Well, when you're feeding your baby and you're starting to see it immediately flare up and get angrier, that's pretty clear. Right. It is. It doesn't always happen, right? But it typically does. Right.

SPEAKER_00 31:31

And and it's dose specific. So if mom has a big load of dairy for breakfast, that baby's probably gonna break out more at that next feeding.

SPEAKER_02 31:40

Okay.

SPEAKER_00 31:41

And you're right. I mean, when we look at this, it's frustrating to me as a an RN and OB world, you know, working in the hospital for 40 for uh doing my career for 40 years, because a newborn rash looks like a pimple. Nothing surrounding that. No, and it's not diffused, it's not real rough and sandpapery, and it doesn't pop out with feeds. And almost always a cow's milk protein allergy or food, but typically dairy, yeah um, does it get worse? You know, I I may have told you this story before, but I had a mom that had five kids and she would bring them all to see me, and they'd be pristine. Their skin would be perfect when they walked in the door. And I go, you know what I'm gonna tell you. She's I know, I just I don't want to give up dairy. I just want you to tell me. It's terrible. And then two minutes into the feeding, they're breaking out. That's pretty conclusive, but for me, that's a classic sign. And sometimes I'll be talking to the family, we're doing a we're talking through the feeding, and I'll say, I want you to look at the skin. And you start to plant seeds because it's hard to take all that in when you've been told the opposite for weeks. And so we kind of start to talk through that. And almost always there are other symptoms. They're they're gassy, they're uncomfortable, their belly hurts, they're crying or fussy a lot. Parents have to pick their battle. I have some families, some moms are like, I don't want to do diet elimination. You don't, you don't have to. Nope.

unknown 33:09

Nope.

SPEAKER_00 33:10

I may say, give this a trial. And the newer research says dairy is 100% out of mom's body and baby's body in 24 hours.

SPEAKER_02 33:19

Oh, in 24 hours.

SPEAKER_00 33:20

24 hours.

unknown 33:21

Yeah.

SPEAKER_02 33:22

Oh, I didn't know that.

SPEAKER_00 33:23

Yeah. Over the last year, that study came out 24 hours. So where do we get hung up on two to three weeks? Yeah, which is what we heard for years. Well, it was kind of true. The inflammation in the body can last up to two three two to three weeks. Okay. My experience, I'm sure you too, is two, three days. If mom is strict reading labels, getting butter out, getting any kind of traces of dairy out, that baby's already better.

SPEAKER_03 33:48

Which is what I usually say. Give it a solid few days. If it's not improving at all, then again, we tweak the plan. But 24 hours is a game changer. It is. I know. Anybody can do something for a day.

SPEAKER_00 34:04

Right.

SPEAKER_03 34:05

And it's it's hard because sometimes moms will say, Well, I don't eat that much. I know. It doesn't matter.

SPEAKER_00 34:10

It doesn't. I had one gal, and she she's a good friend of mine, but she's like she would text my house every day, do I have to get rid of my creamer in the coffee? Do I have to? So you would just test it for a few days. Yeah. You're gonna pick your battle. I'm not there. Right. If you want to have to decide what works for you. Right. And if you say, My creamer, my coffee, he's gonna cry for 20 minutes, blah, blah, then the morning. I'm willing to put up with that. Right. That's your decision. And just the same thing. I have many moms that will go, Oh my gosh, we tried to reintroduce it in two weeks. No, it didn't work. He's back to fussing, screaming, drying the legs up, you know, irritable, rashy. Yeah. We all pick our battle. And some families, that moms can't wait to get it back in and they'll keep testing every once in a while. And guess what? That's a great test. It is. It is a great test.

SPEAKER_03 35:00

And it's pretty, it becomes pretty clear. Yeah. And again, it's free. Thankfully, nowadays we have so many good dairy alternatives. People do still have to think about soy because that's a natural replacement for dairy. And the protein is very similar to cow's milk protein. And that can also have uh an effect as well. Also, you kind of said blood, and that thought kind of planted a seed. Sometimes we can see blood in the stool when there's a cow's milk protein allergy. Uh, we can see mucusy stools, and sometimes parents have a hard time. Well, what does mucusy stool mean? Well, if you put two side by side, it becomes very evident.

SPEAKER_01 35:45

Right.

SPEAKER_03 35:46

It's stringy, it's saliva-y. Not all blood is obvious to the naked eye. And sometimes they do have to do that test where they will find blood in the stool that's molecular size. Right.

SPEAKER_00 36:00

Or it looks like little uh pepper flakes in the diaper. So it's not always what we call frank or bright red. Okay. No, it can be little black spots in the diaper, and that almost, if you test it, dipstick it at a doctor's office, it's probably always going to test positive for blood.

SPEAKER_03 36:17

Okay, that's good to know. I've never had that visual. It's like little black flecks.

SPEAKER_00 36:21

Yeah. And I will tell you frequently in houses, I'll say, um, can you go pull a poopy out of the diaper pail? Yeah. Or a baby has when I want to look at it. And parents aren't thinking, and I would say if you're dealing with this now, go grab one. Put the diaper together, right? Close it, pull it apart. Are there strands from side to side when you pull that diaper apart? Okay, that baby probably has lactose overload or has a dairy sensitivity. That isn't normal. And I think often a lot of stools I see families think are normal. Do we need to worry about it if the baby is fine in every way, happy, gaming, doing great? No, I don't worry about colors of stools. Nope. But if your baby's having problems, I often see stools that correlate with that. Yeah. You know, and adults are the same, right? Yeah. Stool color tells a lot, just like urine color tells a lot of a story. Um, but I think we get really quick on blowing that off like it's no big deal. You know, a deep, dark green, dark broccoli or spinach color stool all the time pouring out of a baby so their bottom is raw, I will argue is not normal. But we can act like it is if the baby has no other issues. And I would say, well, let's delve a little deeper, like we do. So no gas, no fussiness, wanting to eat all the time.

SPEAKER_03 37:42

And that's where the Venn the Venn diagram overlaps with OAL and CMPA is that green diaper. Yeah. And I feel like there's more frothing. I love, I love that we're just like really getting into the texture and color. I agree. I like it. I feel like OAL can be a little frothy. It can be. And and where CMPA, I don't really see frothy. I see more mucusy, deep green, brown color.

SPEAKER_00 38:12

Yeah. I totally agree. I think that's a really good differentiation. Again, they could have two things going on.

SPEAKER_03 38:17

Absolutely.

SPEAKER_00 38:18

And one thing I want to say is um the research shows, and because you talk blood, blood can be scary. And the research shows that if babies, right now the research shows it could change next week, right? That if babies are having specks of blood, it sounds scary, little bits of blood, there's no long-term negative impact on that baby's bowel.

SPEAKER_03 38:39

Okay, that's what's good to reinforce.

SPEAKER_00 38:41

That's what the research shows. Should we problem solve that out? I think so.

SPEAKER_03 38:47

Yeah.

SPEAKER_00 38:47

I think we should see why that is happening.

SPEAKER_03 38:50

I mean, I guess the the great things about humans and babies is that we can we can heal. There's always ways to heal our gut and to get a healthier gut, and it's not a forever problem. Right. And there are ways to suss this out so that you and your baby can be happy.

SPEAKER_00 39:10

Right. It it and that's what it comes down to. Everything we're talking about today is are you coping with a baby that's uncomfortable and miserable? But you have come to learn that motherhood is hard. And it is. It is. But motherhood is hard. So if I have to wear my baby in a carrier all day because my baby won't scream if I don't, you're coping.

SPEAKER_02 39:32

Yeah.

SPEAKER_00 39:32

I don't. That's okay. That's okay if you choose that path. But I would push back just a little bit if that's happening all day. Why is your baby? This is hard, not everybody's gonna agree, dysregulated. Yeah. Are they dysregulated, never content because they're uncomfortable? Well, probably.

SPEAKER_03 39:55

And I don't want parents to think what we're advocating for is saying you shouldn't wear your baby all day. Never. You have to be able to put them down and they need to be sleep to go to sleep on their own. That's not what we're saying. It takes a long time for a baby to realize they're a separate person. Right. We're not saying you can't always wear your baby, especially if you enjoy that. Absolutely. Right, we're close, I I it it alleviates my anxiety. What we're saying is if you have to do all of those things so that your baby is quote normal, then you gotta, there's just better ways to live. There are better ways to live.

SPEAKER_00 40:39

Yeah. And I think we're in houses every day, so I feel like we're probably pretty good at differentiating cries, right? Yes. And crying, I want my mom, I want to snuggle, I think really truly has a different sound. It does. And crying, mom, I am in pain. What are you gonna do to fix me? That high-pitched, frequent cry, drawing the legs up, just and grimacing. Oh, yeah. That little eyebrow is furrowed and they're miserable. I will never begrudge you snuggling with your baby and wearing them all day long. Love it. But if you're seeing you are doing that because your baby is miserable.

SPEAKER_02 41:19

Yeah.

SPEAKER_00 41:20

And you don't have to change it. This is your journey.

SPEAKER_02 41:23

Yeah.

SPEAKER_00 41:23

But if you call us, you're usually wanting help to figure out what is going on, right? Right. There are other things you can do. So if you are not wanting to wear your baby 24 hours a day because your baby is is not dealing well with separation because they don't feel well.

SPEAKER_02 41:41

Yeah.

SPEAKER_00 41:42

There's not an easy way to say this because it all sounds like you're trying to separate your baby, the baby from the mom, and that's not what we're doing. We all need to be aware when we're coping for our baby who is miserable.

SPEAKER_03 41:54

And so, like you said, if your baby is dysregulated all day, and the only way that they feel comfortable is next to you on you, that's a little bit of a red flag.

SPEAKER_00 42:07

It is a red flag to me. And we want to be gentle and everything we're saying and respectful for every mom that's in the thick of the situation right now. Because again, 24 hours of this, and then us saying, Well, we think, dot, dot, dot, it takes your brain down a totally different path. And so you go from everything online saying, nurture, there's nothing wrong with wearing, da da-da-da. All true. Yep. But sometimes there's something else going on. And if you acknowledge that and you want to make a change to your picture, there are things we can do. Now we'll say also collaborative care because while everything we're talking about is the primary starting point to me. I do think myofascial, I do think chiropractic for a lot of these kids can help. Um, and again, it's kind of taking a look at the full picture. Um, and I'll again, honestly, sometimes mom's plates are so full. Yeah, you start talking about that stuff, and it's like they're there, you can see them glossy. I can't handle one more thing.

SPEAKER_03 43:08

Take this baby anywhere?

SPEAKER_00 43:11

What? Right. And that's oh, I'm glad you brought that up. Yeah. Car seat. Miserable in the car seat. Miserable in the car seat. Can be they need some therapy because their fascia is is tight and they need some comfort.

SPEAKER_03 43:25

You put them in the car seat, they're even more uncomfortable. They scream the entire time.

SPEAKER_00 43:29

Right. Yeah. Reflux kids are miserable in a car seat. They are. Now, I could take that and say, okay, if your bowel is irritable and inflamed because of lactose overload, yeah, you may be uncomfortable in a car seat too. Yeah. So it's not, you know, a wide brush where we say it covers every one of these kids, but there are reasons babies are uncomfortable in car seats. And usually we can figure it out. Yeah. Yeah.

SPEAKER_03 43:54

Okay. So let's just give a quick breakdown. Obviously, we can't cover all the symptoms. But things that are the the top symptoms for OAL, overactive let down and lactose overload in a babe.

SPEAKER_00 44:10

Okay. So for me, um, big volume mom, typically the baby, not always, but typically the baby is struggling at the breast to some degree. Coming off a lot. Coming off, could be, arching because they're trying to get away from the fast flow. These kids often start to live on the tip of the nipple.

SPEAKER_03 44:27

Yes.

SPEAKER_00 44:27

And they right now are surviving two or three months down the road, may not be gaining as well as well because they are now restricting how much milk they're getting by living on the tip of the nipple. Moms could start to have pain from that eventually, but it's a coping technique. Explosive stools, often Dijon mustard or green, often a lot of them. A lot of stools, frequent stools, all throughout the day and night, um, often during the feeding.

SPEAKER_02 44:56

Yep.

SPEAKER_00 44:56

Um, it can be have a strong odor to it. Yeah. Kind of viral in nature to me, um, as a nurse. Those are probably the big symptoms we see the most. And not usually a rash. No. Right?

SPEAKER_03 45:10

Yeah, I don't really see a rash.

SPEAKER_00 45:12

No, that usually goes more with allergy, food allergy.

SPEAKER_03 45:15

Okay. Top symptoms of reflux.

SPEAKER_00 45:18

For sure. And it's different, it's hard because it's similar in appearance, right? But on the breast, you can see them appear uncomfortable, but what they do is they'll get their head in a posture where a lot of times their head, the chin is going down or flexing back to get more room in the airway because the milk is starting to come back up the esophagus.

SPEAKER_03 45:39

So more length than their nut and more so.

SPEAKER_00 45:41

They start to then stretch out, right? Like the soldier, tight. And if you these kids often the parents will say, Oh, yeah, you know, well, we'll stand up in between feeds. We'll stand up, prefers to stand up, right? That isn't okay. The arching, the soldier straight appearances can often be refluxing. Sense in their body. Right. Smacking their lips or looking like they're trying to swallow something back down is another symptom of reflux. Um, again, these kids can gain weight really great because mom's feeding them all day. They don't have to vomit to have reflux. It can just be misery and the foods coming back up, and like you said, self-limiting in how much they'll take in.

SPEAKER_03 46:22

You can even, you may not always see it come up as well, but say your hand is on their back, you can usually feel that.

SPEAKER_00 46:30

You can feel that.

SPEAKER_03 46:30

You can feel that reflux coming up their body.

SPEAKER_00 46:34

One thing, which we didn't talk about this earlier about reflux, but I want to say one thing. We mentioned it last night, but the burping study that came out a few years ago has changed my practice. Absolutely. And these kids with reflux are perceived reflux. We think they have it. I don't move them. No, I don't move them from their current position. I try to have head higher than body, but if they end up in that position after feeding, I don't move them and I don't pound on them.

SPEAKER_03 47:00

I don't teach anybody to do the classic pat, pat, pat on their babies back for a burp. Right. And especially if you have what you perceive to be a refluxy kid, that's going to uh probably elicit another spit up. So we just A, don't move them very quickly. If they're already in a somewhat upright position position, you can just give them a little back rub. Right. If they need to get a burp out, they will often burp themselves.

SPEAKER_00 47:28

And I can about promise you, if we come see you, we're gonna pay put them flat on our scale and they're probably gonna throw up if they have reflux. Every time. Every time. So here we are teaching you. So don't move them after the feeding.

SPEAKER_03 47:40

And then we're gonna wait them.

SPEAKER_00 47:42

Three times, we're gonna put them on a flat scale.

SPEAKER_03 47:44

No, I tell them. I'm like, this is not ideal. I'm sorry, but I gotta get some sort of measurement.

SPEAKER_00 47:50

Some measurement. We like to have some data. But I tell you, then you're trying to guess. And I do like my family's if they think their baby has reflux, and if it's having a gain issue, a weight gain issue, when you see your baby reflux, just like you track some other stuff, this time of day my baby threw up, and this is about how much I feel my baby threw up. Because here's why. It may be a half an ounce to an ounce, which doesn't sound like a lot. By the end of the day, 24 hours, your baby hasn't has not been gaining weight well and they've thrown up five times. Yeah. Well, that's probably why. Right. No matter how much you're feeding them and how much milk you have.

SPEAKER_03 48:25

Exactly. Yeah. Okay. CMPA, cow's milk protein allergy, or any kind of food allergies, top symptoms.

SPEAKER_00 48:33

Well, I think familial is a nice thing to know. So not all families are going to have cow's milk protein allergy or they're not going to be aware of it. But especially if a sibling had it, there's likelihood the new baby's going to have it. You know, we don't start there unless the mom wants to with elimination diet. But if we have these classic symptoms, the sandpaper red rash doesn't have to be present all the time, can come and go. Um, quote, fussy or colicky behavior more than they're happy. They can be, they can have weird stools that have funny odors to them, and they can be odd colors. They can show little black specks or bright red blood in the stool, but they don't have to have any of that. And like you said, classic mucus in the stool. Um, sometimes it's obvious mucus strands. Sometimes we put the diaper together, pull it apart, and we see it. It's such an epiphany for families when they see that that they're not thinking it's dairy at all.

SPEAKER_03 49:29

No, I I really do like that visual um because it gives them something concrete. Right. It's not so abstract.

SPEAKER_00 49:38

Right. I agree.

SPEAKER_03 49:39

That's when it's the hardest thing, when it feels abstract. You're like, I don't know what you're talking about. I'm just gonna keep living my life. Right.

SPEAKER_00 49:45

And you can. Yeah. You can live your life. This is your life. Yep. And I'll tell you where I get the most pushback, and it is so hard, and I know because I'm gluten-free and 99% dairy free. Um, when we move through dairy and soy, and we I do those individually because I don't want moms to not have food choices. When we go, okay, soy was not at all an impact, dairy was, we're gonna keep dairy out. Now we're gonna move on to another food group. That is the hardest thing in the world. And some moms are all about it, they're tracking the food thing.

SPEAKER_03 50:18

It doesn't feel like a big uh burden.

SPEAKER_00 50:20

I know. Now, my most recent, this was horrible because I am a Mexican food lover. Yeah, but I it a mom sent me her 24-hour diet. I usually ask for two to three days, and I went, we'd been doing dairy and soy, and I looked at her diet and said, Oh my gosh, girlfriend, citrus. You have tomato-based something or citrus every single meal. And her poor little baby's face was just beat red after every feeding where mom had had a load prior. So it's those things rare, much more rare. Yeah. And I hate having to say it to mom. You know, we we need to work through the food allergen list because there's nothing else here that fits this picture.

SPEAKER_03 51:00

And like you said, there's sometimes where the best option for the family is moving to an allergen-free formula. And if that is something that you prefer, make the decision that feels right for you.

SPEAKER_00 51:12

That's right. If you've had a baby, I support you 100%. You, in a most recent case, you had a baby screaming for six or seven weeks. We worked through food allergies, we've honed in on big culprits, but you're and do baby's doing better, but not 100%. And now you've seen the light at the end of the tunnel. Yeah.

SPEAKER_02 51:31

Yeah.

SPEAKER_00 51:31

We're gonna move on to goat's milk, and then we're probably gonna move on to amino acid-based if we can't do more elimination diet. And that is a hard call to do more elimination diet for a mom. It is, it's a hard thing. And I won't put that off on anybody. It's gotta be a mommy choice at that point for sure. And all this is.

SPEAKER_03 51:49

I feel like a lot of these babies get quote diagnosed with quote colic. And and it really is unfortunate because I cannot stress it enough. That doesn't mean anything. Saying your baby is colic means they're uncomfortable, and we can usually figure out why they're uncomfortable.

SPEAKER_00 52:09

Had uh a patient be told that on the phone by a doctor on call this weekend. And I understand, I do. I've managed an OB group. I get it. You're on call, you're responding to a hundred calls that aren't your patients, it's probably just colic. I I feel compassion for you, and you just told somebody something to mom she already knows is not a good term. Yeah. So she that is lack of respect, right? Right. You have lost her. You have lost her, and you know what? She is not respecting you at this moment because that was an easy out. Yeah. And that makes me sad for you too, as a doctor, because you can do better.

SPEAKER_03 52:44

Probably. Do you feel like they've gotta know that's a nothing diagnosis, or do you think some still kind of live by it? Oh, babies just cry. That's just what they do.

SPEAKER_00 52:54

I do think a lot of doctors still live by that.

SPEAKER_03 52:57

That's a bummer.

SPEAKER_00 52:57

It is, but you know, if you think I am guessing, but a lot of them see 20 to 40 babies a day or children a day.

SPEAKER_02 53:04

Sure.

SPEAKER_00 53:04

I don't know what percentage it's all different, how many babies they see, right? Yeah, that's all we do. We see babies all day long for feeding problems, fussy baby, yada, right? That is not their primary focus. That's nothing against them.

SPEAKER_02 53:16

Yeah.

SPEAKER_00 53:17

That isn't. But be I would just say, you know, I never leave a house. Again, we're in a different field where I go, well, this is just normal. No. I'm sorry, it's gonna get better eventually. Yeah. I mean, we we would not be seeing moms if that was our answer to things. Truly.

SPEAKER_03 53:35

We would they wouldn't trust us anymore.

SPEAKER_00 53:37

That's right. And again, pediatricians, their plate is so incredibly full, and I do not have their knowledge base, but where feeding is concerned, fussy baby syndrome, FBS, fussy baby syndrome is concerned, there is a reason, and we need to be fair to these families and figure it out. Yeah, agree.

unknown 53:59

Yeah.

SPEAKER_00 53:59

We fixed everything. We did. We're saving the world. We are. All right, let's bust some mess. All right, what mess are we busting?

SPEAKER_03 54:09

So it kind of is surrounding this whole topic. So we've got three that we're gonna bust. Number one, if a baby's gaining weight, spit up is just a quote, laundry problem. Can't stand that statement. I know. I can't stand a laundry problem. Again, so invalidating.

SPEAKER_00 54:26

So, and then nothing else is gonna happen. That mom is gonna put up with that vomiting for that baby's whole life until that baby's little esophagus is is healed and growing and mature. That is not fair.

SPEAKER_03 54:39

Just because they're babies doesn't mean they don't know what's going on in the world. How would you feel if you were vomiting after every time you ate? I know.

SPEAKER_00 54:50

That is not and that becomes their norm.

SPEAKER_03 54:53

Yeah, that becomes their norm.

SPEAKER_00 54:54

Oh my gosh, I know it makes me very sad. And you know, nobody wants a baby on medication for reflux. No, not to be able to do that. Nobody wants that. Nope. And so you do everything in your power to prevent that. And then you make a choice. Okay, yeah, this baby could live like this till nine, ten months, or be on a low dose medication and make a difference. Right. What's it gonna be?

SPEAKER_03 55:17

And it's and I tell them it you'll pr you'll know pretty quick if the trial of reflux meds are gonna help.

SPEAKER_00 55:24

I agree. Yeah, the research says about two weeks, but I'm with you. I usually see improvement in two or three days.

SPEAKER_03 55:29

Yep, pretty quickly. And sometimes if it's the right dose, no, maybe they need to go up a little bit, they'll find the right dose, but we typically see benefits pretty quickly.

SPEAKER_00 55:39

That's right. And if you're seeing, that's a great point, you're seeing improvement, but it's not a hundred percent, you need to reach out to your doctor and ask them if they'll tweak the dose. Now I would give it some time to see if it's really working or not, but don't feel like I already asked him, and he said, I really don't want to, but he did it anyway. That don't feel that shame and guilt.

SPEAKER_03 56:01

Advocate for yourself and your baby. And that's why we say a trial of reflex med. It's not like we're saying your baby needs to be on this forever. Let's see what helps them. Let's try to figure this out. Yeah. And I think that's a reasonable request of someone's pediatrician. Can we please try this? We're all miserable. Exactly. Okay. Myth number two, you have to eliminate dairy immediately.

SPEAKER_00 56:29

So I would personally say, maybe not what you want to say. I think we don't need dairy in our diets. However, no. Yeah, yeah. You know, we don't need it. All that advertising was great, right? With the white lip and dairy. Yeah.

SPEAKER_03 56:46

Uh-huh. I got milk.

SPEAKER_00 56:47

Yeah, got milk. Yeah. Okay. We don't need it. We don't have to have it. Even if somebody tells you you have to, I know I'm going down the wrong path for you. No, but you have to have it for calcium. No, we don't need it. Right.

SPEAKER_03 56:58

But for those of us who love it, the myth being that you have to eliminate it immediately or even preemptively, some moms do.

SPEAKER_00 57:10

Right.

SPEAKER_03 57:11

Is not accurate.

SPEAKER_00 57:13

It isn't accurate. And I'm going to be the devil's advocate here on both sides, okay? Sorry. That's just how I am.

SPEAKER_03 57:20

This is how we, this is this is how things be.

SPEAKER_00 57:22

Yeah. So, no, you don't have to eliminate dairy right off the bat because your last child had a dairy intolerance. Sure. Or you're fearful that baby may have. No, I wouldn't say that. I will say, again, back to genetics, if you have MTHFR gene, you don't have to eliminate it to breastfeed your baby, but you're more likely to have a baby that will have issues with it.

SPEAKER_03 57:47

Yeah.

SPEAKER_00 57:48

One thing we didn't say that we do need to say, if you're going dairy-free, and this should go without saying, but it doesn't, if your baby is also getting formula, you've got to use a dairy-free formula. And it's not lactose, it's not lactose-free. Right. Don't buy that. Dairy. Dairy-free, which is a soy-based or it's a goat's milk. And I love goat's milk formulas. Not all goat's milk formulas are pure goat's milk. So you have to read a label and know if they also have dairy in them.

SPEAKER_03 58:15

That's the hardest part with any elimination diet is reading labels and getting yourself very used to that because dairy is in everything.

SPEAKER_00 58:22

It is.

SPEAKER_03 58:23

And sometimes in antibiotics.

SPEAKER_00 58:25

Oh, I know. That's so true. And they're not going to tell you. Even if you have dairy or cow's milk allergy in your history at your pharmacy, they're not going to look that up for you. No. So you may want to just say, they'll call the manufacturer or find out for you if there's dairy in it once you make them aware. You say, not just in your notes, but that you go, is there dairy in this? They're not going to do it for everyone if you don't ask.

SPEAKER_03 58:51

Yep.

SPEAKER_00 58:52

Yeah.

SPEAKER_03 58:52

Okay. All right. Myth number three: a baby has to get hind milk in order to gain appropriately. We kind of already touched on that.

SPEAKER_00 58:59

We kind of did. I, you know, again, there is not good terminology, even for our boards, our international boards, we no longer are tested over the terminology hind milk for milk. There just is not a good term for it. I can say first milk, last milk. It isn't good terminology because it's changing constantly, breast to breast, baby, uh, body to body. It's constantly changing. I often will say, because there isn't a good term, skimmer, it's more skim milk. Um, and it's I don't worry about the appearance. It's just watching how baby's behavior is. That's probably what's going on. Yeah. Um, oh, one thing we didn't mention, which I do want to mention, because there is there are two studies now. If we think that we have um overactive let-down lactose overload, doing the breast gymnastics to mix some of the fat into the milk a little bit more.

SPEAKER_03 59:58

What is that? What's breast gymnastics?

SPEAKER_00 1:00:00

Breast gymnastics, this first gal out of Russia did a study of lifting the breast off the chest wall, up and down, back and forth, in and out on the chest wall. And they found you actually can mix the more, again, not a good term. I like it better than four milk and hind milk, the more skim milk with the globules of fat that get stuck on the ducts. A literal milkshake. A literal milkshake. Yeah. I love that. Literally. And so remembering that can help a little in this. It may not fix it 100%, but for big volume mamas, doing the milkshake dance, right? Back and forth, up and down, circle right, circle left, can actually help mix the family. Oh my gosh, I love that.

SPEAKER_04 1:00:43

Oh, yeah.

SPEAKER_00 1:00:43

That's so cool. And yeah, so this gal that I've heard talk, Maya Bowman from Russia, did a great um study, and then um another one, and I can't remember who it was that did it. So just kind of replicated that. So it's so interesting. Yeah. So that's one of the easier things to do. I didn't mention.

SPEAKER_03 1:00:59

Yeah. Yeah. Okay, so some listener questions. We got one via email from Madison, and she says, Hi, can you review guidelines for storing breast milk, freezing breast milk, thawing breast milk, all things really, and cleaning, sterilizing bottles and pump parts. There's still a lot of misinformation about this and having to like sterilize something every day.

SPEAKER_00 1:01:23

It's gonna change every day. It really is. The CDC, World Health Organization, best practice for storing milk, they're all different. They are. That's the confusing part. So, what do you tell your patient? So, right now, today, I'm saying that breast milk can sit out four to six hours, fresh pumped breast milk, up to six days in the fridge, fresh pumped breast milk. This idea that um as soon as the baby's mouth has been on the bottle, we're finding if it's breast milk, it's much more forgiving than we thought. Yep. But everybody wants to be cautious. So we used to say an hour for formula, two hours for human milk. We really think it's probably closer to the four to six hours, but that's not conclusive. Okay. Okay, but it's much more forgiving than we used to think.

SPEAKER_03 1:02:08

And I I read it was baby's mouth has been out of bottle. You have 24 hours to use it.

SPEAKER_00 1:02:15

Oh my gosh, well, that would make me drilled.

SPEAKER_03 1:02:18

I hope that's the case. Yeah, because I have a hard time standing up on that.

SPEAKER_00 1:02:26

Okay. Was that the German study that came out recently? Okay, see, I missed that. I missed that part. Okay, good, good, good. That's where I didn't finish that. Okay.

SPEAKER_03 1:02:36

So typically, room temp after pump, four to six hours. Typically, pumped milk in the fridge, four to six days. Right. Regular freezer, six months, deep freezer, 12 months. You do not have to sterilize your bottles and pump parts every day.

SPEAKER_00 1:02:54

You don't. If you have well water, it's different. Okay. But you know, and again, when we start looking at all these standards, it's international. And we, for the most part, not everywhere, has a clean water source. So, really, in the United States, the thought is really all this sterilization, everybody's bought a sterilizer. It isn't necessary.

SPEAKER_03 1:03:12

Not necessary.

SPEAKER_00 1:03:13

And unless you have a compromise baby, a baby that's been ill, sure. So we're gonna take more precautions with that. Yeah, for sure. So I think there's some excellent research coming out on it. You're confused as a patient or a mama because it is confusing. There's a lot of conflicting information. I would say even the storage of breast milk for length and longevity, we are not always talking about the same thing. When we talk about that, so when we talk good, better, best three months to 12 months, basically breast milk can still be good nine to 12 months. It just doesn't have as many antibodies in it. Sure. Right? It has more than formula. Right. Yes. That's the point. That's the point right there. So do we have to throw it away at nine months? No, we just need to be aware the IgA is lower the older that milk is.

SPEAKER_04 1:04:02

Sure.

SPEAKER_00 1:04:03

And but again, it's one of the most confusing questions because we're a new science and we're getting new data every day. That German study I've read, but not deeply. I need to get back into it again. Yeah. Yeah, it's pretty exciting. It is. And then who are you gonna believe?

SPEAKER_03 1:04:17

The German study, the best practice, or CDC or etc. World Health. I mean, so Madison, we understand your confusion because we can also be confused.

SPEAKER_00 1:04:26

Absolutely.

SPEAKER_03 1:04:27

Okay, Erica asks, do you recommend pumping until the milk stops flowing or pumping just to replace a feed? So those are two separate questions to me. We're never truly empty, and we can typically elicit more letdowns if we stay on the pump. So, good rule of thumb, I tell moms, is when you're pumping to replace a feed, it's 15 to 20 minutes, or until you get what baby needs, plus maybe a little bit more for storage.

SPEAKER_00 1:05:00

Yep, I agree. I love that answer.

SPEAKER_03 1:05:02

So if you get four ounces in 10 minutes and your baby takes three ounces, you can be done. Turn that pump off. Nobody likes the pump. If you're still working up your supply, it's been 20 minutes and there's not much else coming out, just turn the pump off. You do not have to be pumping every two hours. No, every three hours or seven to eight times in 24 hours if you're exclusively pumping.

SPEAKER_00 1:05:29

Right. I agree 100%.

SPEAKER_03 1:05:32

Pumping just to replace a feed, that's a whole other story. Are you talking about work? Are you talking about your baby's getting a bottle, but you're home? That's kind of a case by case basis.

SPEAKER_00 1:05:44

Well, I think you answered it well, though. I think the 15 to 20 minutes is most women, but if you've got a big volume, you're getting a lot out quickly. Just what you said to me. What is the baby normally taking, or their age based volume? Um, plus maybe a little extra if you want. To store in the freezer. And then the others, again, we're all different. There are some moms that could pump 24 hours a day as you, you know, still get milk out. Yeah. No, we don't need to be tied to a pump. And I don't have any moms, even my exclusively pumping moms, that want to pump. No. There's no fun in that. There is no joy. So I think limiting to just what you said, length of time, um, is number one for most moms in the early days. There are moms that are big volume moms. They're not pumping every three hours anymore if they're exclusive pumpers or even pumping to replace milk.

SPEAKER_03 1:06:32

They take it six times a day. Right. And they have what their baby needs.

SPEAKER_00 1:06:35

They have what they need. Exactly. Every mom and baby are a little bit different with that.

SPEAKER_03 1:06:39

Yeah.

SPEAKER_00 1:06:40

So yeah, I love the idea of what is my baby taking? That's what I'm going to pump out. And some moms will say, but I still have milk in there. I'm still uncomfortable. We don't want you uncomfortable. But those moms with big volume, sometimes we keep ourselves in the bigger volume phase because we keep pumping, pumping, pumping, pumping. Right.

SPEAKER_03 1:06:57

We're like, but I still feel uncomfortable. I'm going to pump. Well, you're actually creating a cycle. You're telling your body, I need more milk. And so your body's going to make more milk. Right. And you're going to keep having this uncomfortable feeling. So that's a whole other topic. It is a whole other topic. But basically, if you're away from your baby at work, whatever, yes, you are going to be pumping to replace a feed. If you, if your baby is getting a bottle, say you're getting some more hours of sleep, you do not have to wake up and pump at that time if you don't want to.

SPEAKER_00 1:07:29

Right. And I think this will be a great show. We need to really do a show on pumping.

SPEAKER_02 1:07:34

Yeah.

SPEAKER_00 1:07:34

And how to use a pump because there's so much terminology here that's very individualized. And even how pumps work, all of that. That'd be a great show.

SPEAKER_03 1:07:44

It would be a great show. Yeah. That might even, we not might need to do a visual for that one. I agree. Or video. Yeah. Okay. So if you have any recommendations or there's a topic that you want us to cover next, please reach out. And as always, moving forward, send in your questions for us to answer in the next episode. Our email is the feedinghotline at gmail.com. You can send in a voicemail at speakpipe.com forward slash the feeding hotline. All of those things are in the show notes. You can click on them and it'll take you right to it. Tell us if you'd like to stay anonymous. We will always protect your privacy. Please give us a five-star review if you're feeling generous. It helps other people find this podcast. And as a reminder, while we are IBCLCs, this podcast isn't a substitute for individualized care. If something feels off, it's always worth getting one on one support.