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Wednesday
Oct092013

Block Feeding Dos & Don'ts

This morning I talked with a breastfeeding mother whose story is becoming all too common. Her 1-month-old third baby was having trouble coping with her fast milk flow. At many feedings, she coughed, sputtered, and sometimes pulled off the breast crying. This mom assumed from this behavior that she had an overactive let-down (OALD) and started a strategy called “block feeding.”

 

What is Block Feeding?

Block feeding involves restricting baby to one breast for 3-hour or longer blocks of time before giving the other breast. It is very effective at bringing down milk production when a mother is making way too much milk. Allowing the breasts to stay full for a set period of time sends the signal to slow milk production.

 

Block Feeding Dos

This strategy can be a lifesaver in some cases, as oversupply (aka “hyperlactation” or “overabundant milk production”) can decrease quality of life for both mother and baby. For a mother, the drawbacks include regularly full and uncomfortable breasts and recurring plugged ducts. For the baby, oversupply can cause a very fast milk flow that can be hard to manage. In this case, block feeding used for no longer than 1 week can be a boon for both mother and baby.

 

Block Feeding Don’ts

What seems to be more and more common, though, is the assumption that any struggle with milk flow is due to OALD or oversupply, when there is usually another cause. As a result, some mothers bring down their milk production with block feeding when their supply is actually at a healthy level, leading to other problems, such as slow weight gain.

 

As I told the mother this morning, during the early weeks, most newborns cough and sputter during breastfeeding some of the time. It takes practice and maturity for babies to learn to coordinate sucking, swallowing, and breathing during breastfeeding. Some episodes of milk flow struggles and pulling away are completely normal and are not necessarily signs of OALD or oversupply.

 

How to Know If Block Feeding Will Help

The most reliable gauge of whether block feeding may be helpful is baby’s weight gain. If breastfeeding is going well, during the first 3 months, most babies gain on average about 2 lb/mo. (0.90 kg/mo.). If baby’s weight gain is double this or more, block feeding for no longer than 1 week makes sense. If baby’s weight gain isn’t this high, it is likely that block feeding will cause more problems than it solves.

 

Alternatives When Baby Struggles with Milk Flow

What can you do if your baby’s weight gain is average but she is struggling with milk flow during breastfeeding? The best strategy is using feeding positions that give baby more control over flow. The most difficult feeding positions for babies from a milk-flow standpoint are those in which milk is flowing downhill into their throats, such as all those in which mothers sit upright.

 

In the feeding position shown at left, however, milk flows uphill into baby’s mouth, giving her more control. See this post to read more about these types of feeding positions and their advantages.

 

If baby continues to have consistent problems with milk flow, it's time to see a lactation professional to check for anatomy, swallowing, and breathing issues. To find a lactation consultant near you, go to this website, click on the "Find a Lactation Consultant" link, and enter your zip or postal code.

 

References

Caroline, G.A. & van Veldhuizen-Staas, C. G. Overabundant milk supply: An alternative way to intervene by full drainage and block feeding. International Breastfeeding Journal 2007; 2:11.

 

 

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Reader Comments (10)

Nancy, Thank you for another informative blog post. I have also found that thanks to the availability and easy access to breastfeeding information that many moms have found information on block feeding and want to try it when their babies are struggling at the breast. These guidelines for when block feeding may be appropriate are very useful to help moms protect their milk supply and not do block feeding when baby's weight gain is average or normal. Another possibility moms may consider when baby seems to have difficulty coping with milk flow is a tongue-tie or lip-tie. These anatomical variants of oral structures may also create difficulty for babies in coping with normal milk flow. An IBCLC or knowledgable primary care provider can check for a tongue or lip-tie and make an appropriate referral for evaluation and treatment. And as you describe, the uphill nursing positions can help baby cope with flow whatever the cause.

October 10, 2013 | Unregistered CommenterBarbara Hardin, RN, IBCLC

Thanks for this post, Nancy! Turning to block feeding is something that many moms do on their own, usually from info found online; so having your clear explanation pop up in Google searches will give a good perspective for moms to consider before trying block feeding. Additionally, I hunk it's important to emphasis that baby can really struggle with "normal" flow if they have limited tongue mobility caused. by frenulum restrictions (tongue-tie). So it's important that moms also seek help from a knowledgable breastfeeding professional if the problem persists beyond what they can figure out on their own.

October 10, 2013 | Unregistered CommenterAna Estorino Uribasterra

I love what Cathy Watson Genna suggests in "The Dark Side of Block Feeding." She writes, "Block feeding should only be recommended when the infant is consistently gaining more than 8 oz (225 g) per week and has no risk factors for inefficient feeding if the milk production is reduced." I see that would lead to more than a 2 pound gain in a month -- do you feel it is better to look a month at a time or take a couple weeks of more than 7-8ish ounce gains and go from there? I am not a huge proponent of block feeding, and I thought that suggestion of CWG's was a great thing to share with a mom who may want to try block-feeding for perceived OALD.

October 10, 2013 | Unregistered CommenterStacie Bingham

Hi Stacie, I don't think it's necessary to wait a full month before making a decision. If a baby is gaining significantly more than average (7-8 oz or ~200 g per week) and either mother or baby is having issues, block feeding may be helpful. The point I'm hoping to make is that block feeding will *not* help if baby's weight gain is average or below. In this case, another strategy would be better.

"The point I'm hoping to make is that block feeding will *not* help if baby's weight gain is average or below." Absolutely, I totally agree! I see too many places where it is suggested, absent of any other information, that a mother try block-feeding for OALD or "foremilk/hindmilk imbalance" (I also appreciate your current thoughts about that!). It is good to offer additional information on how that may not be the best solution for them until many other factors are known (and she has been advised by a real-life IBCLC). Thank you! I appreciate your knowledge and your willingness to share.

October 10, 2013 | Unregistered CommenterStacie Bingham

Thanks, Barbara and Ana for your comments. I've added a short paragraph at the end of this post, as I agree that mothers should contact a lactation professional if their baby is still struggling with milk flow after adjusting their feeding position.

October 11, 2013 | Registered CommenterNancy Mohrbacher

Often babies pull away from the breast because the flow slows and they get frustrated..breast compression whilst feeding....to increase the flow is advisable...the increase in the flow stimulates the baby to suckle again.
Offering the other breast also helps because the flow will start again...so in this situation it's definitely not advisable to block feed...it's easy to see that new mums can become confused.
I think it's really important to spend the time watching the feeds.
I always start with good positioning....correct, deep,asymmetric latch...checking for tongue tie if that's not obtainable...rhythmical suckling with a pause before audible swallowing...(see Dr Jack Newmans website and videos on you tube...

October 19, 2013 | Unregistered CommenterChris Higgins Midwife LC

Why do you set a time limit of one week for blockfeeding? And, I am also wondering why there was no mention of the color of stools while considering oversupply ax a possible breastfeeding issue?

November 2, 2013 | Unregistered CommenterEmily

Hi Emily, Thanks for writing. In answer to your questions, I set a time limit on block feeding because in the vast majority of cases, one week is all that's needed to bring milk production under control. However, many mothers keep doing it longer and end up bringing their milk production down too far.

I don't mention stool color because this is another "hot button" issue that many moms misinterpret. Green is in the normal color range for stools and it can also be caused my factors completely unrelated to oversupply. Some babies develop green stools when mothers consume green foods or drinks. Another possible cause is a stomach bug or a sensitivity to a food or drug mother takes. For many mothers, a change is stool color leads to the automatic (but often incorrect) assumption that they have oversupply or a "foremilk/hindmilk imbalance." For more on this, see my blog post on this at: http://www.nancymohrbacher.com/blog/2010/6/27/worries-about-foremilk-and-hindmilk.html.

Great Post! I know I struggled with overactive letdown early on and block feeding did wonders for us! My daughter was jaundiced so her pediatrician had me pumping to supplement(with a syringe and feeding tube) from day 1, so once my milk came in my let down was extremely forceful and I definitely had an over supply(still able to pump almost 10 ounces after a feeding). Block feeding made things so much easier on her and we still block feed for a few feeds a day with a few on both breasts. She is almost a year and our breastfeeding relationship has no end in sight!

November 20, 2013 | Unregistered CommenterLiz
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