September 28, 2010 35

Breastfeeding Supply Issues and CCK: Your Supply is Fine, It's Your Timing That's the Problem!

By in baby, breastfeeding, development, diet & nutrition, health & medicine

“My baby eats all the time! I think I need to give him formula to satisfy him.”

“When my baby falls asleep with a pacifier, he seems much more satisfied, but I'm always engorged.”

“No matter how often she eats, I feel like she wants to eat again in 10 minutes! I must not have enough milk.”

It's a very common issue: mommies think that because their breastfed baby just wants to eat and eat (and eat and eat), that they're either not producing enough milk, or the baby just needs way more than mom can make. I'm here to tell you, in most cases, it's just not true!

Babies have this neat hormone in their system that tells them when they're full (high levels) and hungry (low levels). It's called cholecystokinin (CCK), and it aids in digestion and gives feelings of satiation and well-being in mom and baby. When a baby nurses for a good amount of time, their levels rise and they may get that milk drunk look or just fall asleep. After a nice little nap, their CCK levels drop a bit, so they want to nurse again. They may not actually drink, but just suck until they fall back asleep.

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Giving a pacifier can trick this hormone, since it's created by sucking, but can mess with your supply, and make baby cranky when she wakes up. Breastfeeding your baby when she's fussy is the best way to restore those full CCK levels and make a happy baby once again. It's been found that babies with colic have lower levels of CCK in their systems, usually because of an abnormal amount of spitting up. These babies may need a pacifier to help calm them and raise their CCK, when nursing just won't cut it. The most important thing to remember when using a pacifier is “If you have to, use it, don't abuse it, quickly lose it.” (Dr. Sears)

CCK is nature's alarm clock; a very well organized “schedule” to keep your baby well fed and build up your supply. So keep feeding that baby on cue, don't give that unnecessary bottle or pacifier, and you'll find yourself in a happy nursing relationship for months (or years) to come.

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35 Responses to “Breastfeeding Supply Issues and CCK: Your Supply is Fine, It's Your Timing That's the Problem!”

  1. Christie
    Twitter:
    says:

    Great info! You’re the one who taught ME about this. :)

  2. melanie says:

    And I was just waiting for you to write something about it! Glad you didn’t, because I knew exactly what I wanted to write!

  3. Keri says:

    I illustrated that point a couple of hours ago. My baby (19 months old) nursed to sleep for a late nap. She woke up an hour later and nursed herself back to sleep. She slept for another hour. Then she ate half my dinner. Breast milk is no longer her only source of nutrition, but it is still a very important part.

  4. My son did this for a looooooong time. He’d wake 40 min. into his nap and need to nurse back down. Same thing several times a night. He is 14 months. Now he is starting to sleep longer stretches at nap and night without needing to nurse. He was exclusively breastfed until 8 months so he is only starting to eat a LOT of solids now.

    If you have other kids…get a sling you can nurse in, you will need it! (I have a 32-month-old also who, yes, is still breastfeeding.)

  5. Stassja says:

    This is really interesting! My first was an easy baby, slept massive chunks, nursed with zero issues straight through the first year (when he abruptly weaned once he figured out falling asleep on his own). My second though…we are going on a year in two weeks and he still wakes every hour most nights. (By most I mean…once a week we’ll get a night with a couple 2hr stretches) We’ve tried some sleep training, which helped him with calming down initially for the night (bedtime used to be literally hours no matter what I tried). Some nights it’s more like every 40 mins. I think he was meant to be a thumb sucker, he started sucking it at a few months old but was still tongue tied, which was causing him pain, nursing was not comoforting for him but he suffered through it, but the thumb went by the wayside. Then we got it clipped, nursing is 100% better for him, but he’s never found interest in the thumb or paci again. He eats three solids meals a day and it didn’t affect his night waking one bit, so I must conclude that I’m not starving him.

    (Was starting to wonder if ODS weaned at 1 because of my supply, I’m thinking not)

    Anyways sorry to ramble. This is still a nightly struggle for me to be ok with (I also have the three year old and a deployed spouse so I’m pretty much insane from sleep deprivation at this point) and it’s nice to hear that there’s probably nothing wrong with him, or me, or the way I’m doing things. It’s just how it needs to be for him.

    • bjartgoddess says:

      Just to let you know my last two kiddos were the same way. Neither one slept through the night or even came close until about 18 mos. My son who is 16 months, doesn’t nurse very often, because I am pregnant and due in 10 weeks, so milk is gone. But he does still sleep on them and wake at night to lay beside them. I am very eagerly anticipating my babys arrival, so he can get to nurse again. I know he wants to, he does still try. Anyway, just a comment to let you know that you are not alone. My 5 year old was worse than my son. She literally woke up once an hour or more often. It was awful. But she really enjoyed nursing, so it was worth it. (She eats like a bird now, though)

    • Lydia says:

      Stassja:

      I am so sorry! I cannot imagine doing that for as long as you have…my daughter nursed for a year till she self-weaned and was an excellent sleeper, just had a couple of rough nights.

      When your younger son wakes every 40 mins.-hour at night, is nursing the ONLY thing that will get him back to sleep? The reason I ask is that I have only ever even HEARD of one baby that still woke so much at almost a year despite sleep training. Many babies do that, but usually because the parents aren’t sure how to stop it. With this baby’s older sister, her parents knew when to start sleep training because she stopped fussing as soon as they came in at night. With Abby, literally nothing makes her stop crying but nursing, and all the professionals are baffled because it’s so unusual at her age (10 mos.).

      I would consult your pediatrician or even one who specializes in infant sleep. Children at ALL ages do actually need 10-12 hours of CONNECTED sleep, their stomachs just can’t allow it when they’re newborns. The goal of getting them to sleep through the night isn’t just some “selfish” parents’ desire…it’s actually best for them, too. They feel just like we do after such disjointed sleep.

      Don’t let ANYONE make you feel like it’s selfish to want better sleep for yourself (I don’t know if they are, just saying this in case)…you’re not talking about getting 5 hrs. and wishing it was 8. This is almost NO sleep, and such short chunks aren’t allowing you to get through even one sleep cycle.

      We can’t be the best parents possible if we’re that sleep-deprived. Usually it just means we’re more short-tempered and easily frustrated, but it can actually be DANGEROUS; not only to our own health, but to the children we’re taking care of (many studies have been conducted on the human brain’s inability to function properly with too little sleep). When we’re that delirious, our judgment and reaction times are much poorer, and a laundry list of other problems.

      Don’t be afraid to ask for help, it’s not selfish! Some moms will think they’re putting their children’s needs first by sacrificing tons of sleep for them, but that’s not what’s best for our children…we need to be on our “A” game when caring for our little ones! I know tons of things that worked for us and would be happy to share, but this is getting long and since I don’t know your situation, I don’t know if they’d help.

      Good luck!

      • Christie
        Twitter:
        says:

        It is perfectly acceptable for even a 2 year old to wake up once or twice a night to nurse. It is in absolutely no way damaging.
        You can encourage daytime nursing, and try to feed more in the evening (though avoid a huge meal right before bed that makes it hard to sleep) and that can help cut down on night nursing, but often night-time nursing is the LAST nursing to go.

        Even adults often wake up multiple times during the night, but because you are completely capable of knowing you need to go right back to sleep, it’s not even a blip on your radar most times. So for a toddler to wake up once or twice to nurse back to sleep is absolutely not a medical problem in need of sleep training and a doctor’s specialty help.

        • Lydia says:

          Of course, once or twice a night would not be such a problem. Every hour or more all night is a MAJOR problem, though. I completely agree that it doesn’t cause a blip on our radar when we wake up and go right back to sleep, but getting up to nurse constantly requires us to actually wake up to take care of an infant, which does disrupt sleep, especially when done so often. The 10-month old I referred to wakes up 6-7 times a night…that’s almost as often as my daughter nursed in an entire 24-hour period (7-9) as a newborn! That often is not normal, especially at that age.

  6. Melanie says:

    Stassja, you may find that once your babe weans (and he may be a 3 year old self-weaner), he’ll be extremely independent and you’ll miss the days where you *had* to cuddle him ever hour or two. I know it’s hard to think that far ahead, but try to treasure the time you have now, and know that if you just go with the flow of things, it will probably be easier and less of a struggle. :)

    • Stassja says:

      Thanks Melanie. It’s stressing me less the more I accept it, and he is for sure a happy, peaceful, secure guy during the day. No issues leaving mommy (unless he JUST woke up, then he needs some cuddles before he’s ready to explore and do his thing) and he is a really chill guy. :) (He even allows others to rock him to sleep when his belly is full so when the hubs is home I’ll get a bit of relief!)

      • Melanie says:

        Good to hear. :) My 19 month old is finally letting me say “All done,” and fall asleep on her own. It’s quite a relief to my sore pregnant nipples.

  7. Erica says:

    This is great information, Melanie! I was fortunate that once my daughter realized that a pacifier was a replacement for a nipple, she refused to use one. She has very high standards.

  8. Kara says:

    Great info! This really shows how “smart” our bodies and our babies are and why it is so imporatant to respond to baby’s cues.

  9. Kara says:

    Great info! This really shows how “wise” our bodies and our babies really are and why it is so imporatant to respond to baby’s cues.

  10. Faith says:

    It’s always good to have more great breastfeeding info out there! I’ve found it a million times easier to just nurse my babies whenever they wanted, even if it was every hour. A perfect excuse to put my feet up for a few minutes and enjoy my little one. I’ve also been amazed how much more rested I am when sleeping with the baby and just letting them nurse as they liked throughout the night – rather than getting up and struggling to make them sleep on their own or through the night. Also, I have to agree with the lady who suggested getting a sling – I would be lost without my Ergo baby carrier! It is so comfortable I can wear it for hours, can even nurse the baby in it, and it is often truly a lifesaver for me. I wish every mom could have one (www.ergobabycarrier.org). Happy nursing!

  11. Nikole says:

    It’s great to actually see an explanation for this, since AJ’s ped. kept telling me that her eating so frequently wasn’t allowing me to produce milk quickly enough to have enough to fill her at a feeding, which led to her eating again very soon. Of course, I knew he was full of crap (would a starving baby fall asleep contentedly after 5 minutes of nursing, after all?); but I didn’t have the actual reason for it, either. Thanks for the information — at least now I know what to tell other moms who experience the same thing!

    • sharon says:

      (would a starving baby fall asleep contentedly after 5 minutes of nursing, after all?) That answer can easily be YES…my 3-4 day old was practically starving and would fall asleep after 5 minutes of trying to nurse. It can be very exhausting work, esp when there are issues. He was clamping the nipple, which constricted flow. I do not know the mechanics of his issue, but finally took him to a pediatric chiropractor and his C1 misalignment was the culprit. After the first adjustment was 100% improvement, though he was 6wks by then after pumping and bottlefeeding with intermittent breastfeeding to see where we were at and keep familiarity (I worked very closely with a lactation consultant until a friend suggested chiro care too)…so, we had to work in re-training due to immediate flow expectancy etc. with weekly chiro visits. His C1 never became misaligned and we are spreading visits out further now. Been good for about a month now and he wants 100% boob…has refused the pacifier too ;-) Ultimately boils down to persistence to find the problem to know how to fix it and TRUST your instincts to keep looking even when those helping haven’t been able to ‘go further’ in the solutions they are familiar with. Just because they can’t ‘fix’ it doesn’t mean they didn’t do the best to help and most of all SUPPORT you the best they could. When I felt despair I knew I just needed to keep talking to people who asked how things were going. I always shared my problem knowing the solution would eventually appear. ok, enough babbling ;-)

    • Lydia says:

      Well, it’s not so much a problem of producing enough milk TOTAL, but producing a FULL feeding. When babies (or adults, for that matter) eat for about 5 minutes, they don’t eat as much. Then they get hungry sooner, but not extremely hungry, so they just eat another small feeding, which in turn fills them for a shorter time…thus begins the cycle of just eating lots of “snack” feedings instead of fewer feedings but actual meals.

      They may consume the same total ounces of milk as a baby eating every 3 hours or so, but they never truly finish a feeding and therefore never get to the more nutritious hindmilk, which only comes at the end of a feeding (a full meal). If they eat too close together, your body won’t have produced a “full” feeding’s worth of milk.

      • Rebecca M. says:

        Lydia, your point is accurate about “full” feedings in terms of getting adequate hindmilk. Short feeds where the baby doesn’t empty the breast and only gets the sugary foremilk can lead to gastric upset, leading to more nursing (for the comfort factor), exacerbating the problem further. Signs of this in the baby include fussiness at the breast, excessive gassiness and green, frothy poops.

        However, older babies (after 6-12 weeks or so) become VERY efficient at feedings and can get all the fore- and hindmilk they need in just a few minutes. So length of feed is never a good way to know if a baby is getting “enough.”

        Your comment worries me a little because it sounds like you’re repeating old, incorrect rhetoric about infant feeding which frames babies’ eating habits in terms of adult eating habits – 3 square meals a day – which frankly, isn’t the healthiest way to eat anyway, in terms of balancing blood sugar levels. Babies (and everyone else) are designed to consume numerous smaller “meals” a day, whether strictly breastmilk or, when older, a combination of milk and solids. And as far as “snacking,” babies breastfeed for much more than just calories. They nurse for comfort and hydration. Limiting or scheduling breastfeeding based on an adult-centric idea of “how they should eat” is both damaging to the breastfeeding relationship and frankly, insensitive to the baby’s needs.

  12. Nina says:

    I’m thankful I came across this information BEFORE I have my first baby in March. Nursing is the only option I’ve ever considered. I’ve found that the very best information on labor, birth and nursing comes from mom’s who have gone through it. I also appreciate the comments from other mom’s experiences here. Thank you for taking the time to write this!

    • Christie
      Twitter:
      says:

      Please friend our Facebook page and if you have ANY questions, don’t hesitate to ask!
      There are some great breastfeeding resources out there as well. If you’re not going to LLL meetings already, now is a good time to start!

    • Rebecca M. says:

      I really agree with the suggestion to start going to LLL meetings now! You will learn so much, meet other moms who just might become your new friends, and connect with the leaders who can help you after your baby is born. I’ve also found meetings are a great place to connect with women who share your views or can provide info on other topics, like birth, cloth diapering, babywearing, etc.

  13. Nina says:

    I\’m thankful I came across this information BEFORE I have my first baby in March. Nursing is the only option I\’ve ever considered. I\’ve found that the very best information on labor, birth and nursing comes from mom\’s who have gone through it. I also appreciate the comments from other mom\’s experiences here. Thank you for taking the time to write this!

  14. Tara says:

    Great info! I’m still exclusively breastfeeding my almost 6 month old son. Was getting frustrated that he’s not sleeping longer stretches at nights (up every 3 hrs to feed). Sometimes he’ll feed for 20-30 mins, other times he’ll slow down after 10-15 mins… which makes sense now. I’ve had “well-meaning” family members asking if I shouldn’t be feeding him rice cereal to get him to sleep longer at night… I would much rather continue to breastfeed on demand… soon enough this time will be over!

    • Rebecca M. says:

      Tara, my son was the same way. He ate every 2-4 hours at night through 6 months, spaced out a little bit between 6-8 months, then dropped to eating once a night at 9 months. It was really hard for me being so sleep deprived, but that was partially self-inflicted because I gave in to pressure to move our son to a crib in his nursery (adjacent to our room) at 6 months, which meant I was getting up and trudging to his room multiple times a night to nurse. Next time I plan to co-sleep and avoid that hassle!

      At 11 months my son suddenly started sleeping 12 hours, but we’ve had our share of “regressions” for teething, illness, or just when he couldn’t sleep! He’s now 20 months and the last time he nursed at night was maybe 3 months ago? Probably right around when I got pregnant and I knew I needed to get more rest, so my husband and I both started focusing on other ways to soothe our son when he wakes at night. We still don’t make a big deal when he wakes up at night — we know that EVERYONE wakes up at night and we acknowledge that sometimes it’s hard for us to go back to sleep, so why wouldn’t it be hard for a toddler?

      Anyway, I really believe that eating frequently at night IS the normal way for infants. It just seems “abnormal” in our society because most babies aren’t being fed the normal way. Infants need to get 100% of their nutrition from breastfeeding for the first 6 months or so, and milk should remain their primary food through the first 12 months. It only makes sense that some of that nutrition will come during sleeping hours, since that’s half (or more!) of the baby’s day! And especially when you consider how distractible and BUSY older babies can be, it’s much easier for them to get their calories when they’re sleepy and CALM! But in our society, where hard-to-digest artificial milk is the norm and babies are sleep trained (aka, conditioned to stop signaling their needs) as young as a few days or weeks old and solids are introduced WAY too early…it’s not surprising that people have some backwards ideas about what’s “normal.”

  15. Jen W. says:

    My baby is 3 weeks old and I have seen that “milk drunk” face too, love it. :)

    But I am curious because we have the opposite problem as this article, sometimes he will be content to nurse for 30 minutes and then happily sleep 4-6 hours unless I wake him up. Not always mind you, but most nights we sleep that long unless I set (and hear) an alarm to nurse in the middle of the night, and often in the afternoons I will have to wake him after 3-4 hours to nurse. Everyone else says to enjoy it and let him sleep but we are having weight gain issues… he was 9lb at birth and still only 8lb 15oz at his 3wk checkup. He had gained 2 oz at his 2wk checkup and 3oz at the 3wk checkup. I am just trying to wake him more to nurse, but I do wonder why his CCK or whatever system isn’t telling him to wake up more?

    • Melanie says:

      There are a lot of things that could be involved in slow weight gain. First of all, is your pediatrician following the WHO growth charts? Does he have a really good latch? Babies can have an iffy latch that doesn’t really get milk out at a good rate, they just suck and suck (which would raise the CCK), but not get to the fatty milk. Try cluster feeding, where you feed twice (or three times) from one side, ensuring that he’s getting all the fatty milk, then switch to the other side for 2 or 3 feeds (go by your fullness feeling, you don’t want one breast to be completely engorged while the other is deflated). Hope that helps some!

      • Eden says:

        I would also pump the other side if I was cluster feeding on one side so that the other didn’engourge. I could hold a lot per breast (large breasted, at one point I was pumping 7 oz from one side) and then store the milk. One could also donate. But that was just to keep the supply up and engorgement down.

    • Rebecca M. says:

      I agree with Melanie that it’s important to make sure your doctor is using the WHO growth charts which are based on normal (breastfed) infant growth, not on artificially-fed infants like the old CDC charts. But in this case we’re talking about a 3 week old baby who hasn’t regained his birth weight, so that’s not really a growth chart issue. On the other hand, many babies’ birth weights being are inflated (literally) by excessive fluids delivered to mom via IV during the birth process. They shed that extra fluid weight in the early days, leading uninformed doctors to claim “excess weight loss” and recommend artificial milk or other interventions. :-/ So, Jen W., if you received a lot of fluids during birth, you may want to consider that your son’s birth weight was “off” by as much as a half pound. Still, it does sound like he’s gaining slowly. Many babies are very sleepy in the early weeks, especially if they have any jaundice, and you do need to wake them to eat and work to keep them awake, as well as assessing latch and feeding efficiency. You definitely need to be working with a lactation consultant — keep in mind that most pediatricians have very little training on breastfeeding.

  16. Naomi says:

    Wow, great article! I always thought my babies were just extra hungry because they wanted to nurse ALL the time! They were also CHUNKS! lol Thank you for sharing this information!

  17. Tiffany says:

    The corollary to this that when you’ve got a baby who wants to suck, and suck, and suck, and suck and seems to do nothing but nurse, you can try to jump-start the CCK levels with a bit of skin-to-skin contact and massage. CCK and other gastric hormones “activate” with dietary fat and touch, and one without the other won’t give you the same milk-drunkenness.

    This is one of the favorite things I learned about when I went through my CLC training! Lactation is amazing.

  18. I nursed all my last two babies on demand like this and it worked out brilliantly. Always had more then enough milk and weaning was painless when I let them do it as they were ready. My oldest was supplemented with formula, I was told to nurse on a schedule, and then I was in school and couldn’t nurse as often and it did not go well.

  19. Liz says:

    Thanks for the good reminder. I battle daily with a strong-willed 2.5 yr old, which makes lending my breast frequently to my 0.5 yr old so tiring. Some days I just want my bed back and the thorough sleep that used to come with it.