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  • LACTATION MODULE: The Fussy Breastfed Infant
  • NDC domain #2 (feeds). Frequent flexible breastfeeds, lactose overload, conditioned dialling up, paced bottle feeds

Lactose overload in breastfed babies. Dr Pamela Douglas & Dr Sharon Perrella, F2F Masterclass Melbourne 2018

Dr Pamela Douglas2nd of Jan 202418th of Jan 2024

Pam's comment (erratum):

I no longer describe lactose overload in terms of cream or fat. I've included this video because I hope that the discussion will nevertheless be of use to you.

In this video I state that our management strategy for lactose overload increases total fat intake over a 24 hour period. The UWA research shows similar total fat intakes regardless of frequency of feeding - although if we are not offering frequently, then production will drop, total milk volumes will drop - and presumably total fat content will drop proportionately too. But my comment in this video is inaccurate.

For some years (and in the revised version of The discontented little baby book) I have described lactose overload by focussing on the main mechanism, which is volume of lactose which overloads the lactase in the small intestine, causing lactose to reach the colon, where it ferments. Management strategies remain the same as those I discuss in this video.

Unfortunately many women are still advised to 'drain the breast so that baby receives lots of cream', which commonly results in inadequate milk production for the baby's needs.

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Next up in NDC domain #2 (feeds). Frequent flexible breastfeeds, lactose overload, conditioned dialling up, paced bottle feeds

Conditioned dialling up with breastfeeds: diagnosis + management

baby cries at breast; conditioned dialling up at breast; breastfeeding; baby cries

What are the diagnostic signs of a conditioned dialling up at the breast?

Sometimes, the mother can identify a particular feed when a helper used force to bring the baby on, and from then on the baby dialled up at the breast. Often, the mother has been worried about the baby's milk intake or weight gain, and has been accidentally coercing the little one to the breast. Also very commonly there is an underlying positional instability, which may explain the initial breastfeeding problems that the mother has been trying to deal with.

Conditioned dialling up with the breast occurs as a pattern of infant behaviour over time. The infant shows one or more of the following signs:

  • Dials up when mother lies baby back to come to the breast

  • Dials up as mother brings baby to the breast

  • Dials up...

more articles in NDC domain #2 (feeds). Frequent flexible breastfeeds, lactose overload, conditioned dialling up, paced bottle feeds

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    COMMON BREASTFEEDING PROBLEM #2: not offering the breast frequently and flexibly enough
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    Is your baby unsettled or having trouble sleeping because of lactose?
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    Conditioned dialling up with breastfeeds: diagnosis + management
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    COMMON BREASTFEEDING PROBLEM #3: conditioned dialling up at the breast
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