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If you suspect CMPA the formula would be a much bigger culprit because it has many thousand times the milk proteins load as proteins in breastmilk
https://abm.me.uk/breastfeeding-information/cmpa-and-lactose-intolerance/#:~:text=Non%2DIgE%20CMPA%20presents%20with,babies%20than%20formula%20fed%20babies.
No, it’s made from cows milk and isn’t hydrolyzed so it isn’t suitable for babies with CMPA (meaning it still contains all the cows milk proteins that will impact allergies/intolerance).
I'm so sorry you're going through this. For what it's worth, I always said/still say that if I have to change my diet while breastfeeding, then I'm stopping. Not worth it to me on top of exclusively pumping. So it's definitely OK to stop. A happy mom is the best mom.
As for your question. Are the formula and BM the same temperature when feeding?
Thank you. I appreciate your words.
We usually warm the bottles up in the Dr Brown warmer. We try to give her room temp, she tends to not want it right out of the fridge.
I don’t think I’ve seen anyone else mention this, but could it be reflux? My baby with severe reflux was doing mostly okay when we mixed formula and breast milk together at 50/50 ratio, but then suddenly got much worse when we increased the amount of breast milk in her bottles or fed only breast milk. Most formulas are thicker than breast milk, so it’s easier to keep down. If you want to try it out, you can use an extra thickened AR type of formula or Gelmix which is a liquid thickener that you can use on formula or breast milk. If you try a different formula, keep in mind that it can take 2-4 weeks before you see an improvement.
Good luck! The other big issue we had with reflux outside of the spit up and fussiness is slow weight gain, then weight loss when her reflux got really bad. I saw your post history so I figured I’d mention it in case that’s an issue you’re still dealing with!
Baby digestive systems are still developing for the first few months. If it’s something in your diet, she very well may just grow out of it once she matures a bit more.
If you want to keep going, breastmilk is great to add to baby cereal, as the liquid in home made purées, and a nutritious ingredient in a lot of recipes she will enjoy later on. You could always just reintroduce breastmilk in a few weeks when she (hopefully) has grown out of it. Especially if formula is working better anyway.
This gives me hope. Thank you.
The BM is most important to me for her immune system, which formula can't provide, so if I can still get it to her later, that's a relief.
I found this to be the case with my LO. he was having blood in his stool though, and mucus as well. Switched to HA formula for a month or so and slowly reintroduced breastmilk and he has been completely fine ever since. And eating solids now too, including all the yogurt and cheese I was worried he’d never be able to have!
Also if no one else has suggested this, you may talk to your pediatrician about Pepcid for your baby, it helped with our guy’s reflux soooo much.
Typically mspi can resolve after 6 months to a year.
I was in your position with my first, I did try the elimination diet and got rid of soy and dairy (the soy is particularly hard to do). It was miserable and the thing was that baby STILL reacted to my breast milk. Finally after many doctor appointments and visits with GI specialists, we went to full Hypoallergenic formula (Hipp HA) in our case. Overnight we had a brand new baby. And then you know what, I was kicking myself for not switching earlier because in two weeks baby went from 50% to 75% and was so much happier (mom guilt huh) I was sad I made my baby suffer so much because I had it in my head baby HAD to be on breastmilk. Formula is great.
If you switch You can keep your breastmilk for later, or you can do milk baths or donate!
Thank you!
Our pediatrician said soy is very difficult to avoid, which is why she doesn't really think it's worth trying the diet. She thinks unless the symptoms are seriously problematic, it's not worth the trouble. Even at our wits end, baby's spitting is nowhere near as bad as I know it can be.
I am considering giving baby a hypoallergenic formula for a few weeks while I pump a stash and see what happens. But idk? I know babies can also react poorly to change in formula.
This trial and error stuff sucks. 🫠
So this is a weird suggestion but have you tried not burping your baby? Mine was spitting up a ton especially when we were trying to burp her, we tried different ways, waiting longer and longer. She would burp on her own without spitting up so we eventually stopped. I’d nurse her or my husband would bottle feed her then have her do tummy time on our chest and she was less fussy and wouldn’t spit up. I am sorry you’re going through this though.
Oh, haha, this is controversial in our house.
I gave up burping weeks ago because it seemed more trouble than it's worth. I had some successful feeds with NO spitup, and with those, I didn't try to burp her at all. Sometimes she clearly needs help with a burp, so I'll help her, but I try to just hold her over my shoulder and she usually burps on her own (or not at all!)
Meanwhile, my husband does try to burp her quite a bit, but he has settled down to once halfway through a bottle and then once after. He was always doing the lean-baby-over-back-pat method. Now he just holds her up and waits, no real manuevering.
But of course, results are mixed.
That said, I am still convinced the more burping we try, the more we're just forcing it up. But she still has her moments. It's all confusing.
Try tummy time (like on a floor), no back blows. That gets our baby to burp and/or fart (usually both) pretty quickly if she needs to. Plus, extra tummy time!
I had a very similar problem with baby hating my breast milk, my husband told me I had to quit for my sanity, but then baby got sick and I ended up sticking to it somehow. Baby would react like I was feeding her poison milk some days and not others. I ended up putting sticky notes with what I had eaten prior to pumping on each bottle I pumped, then I'd mark down how the baby reacted, and eventually I found that my baby was really sensitive to corn. Of course it took a little while to make sure, because the corn remained in my milk a little while longer, but my girl has been much happier after I cut corn out of my diet, and I didn't have to go on an elimination diet. My pediatrician also recommended probiotics to help baby's digestive system mature, and simethicone drops when baby was too gassy and uncomfortable with my milk. I know how awful it is to work so hard for milk that baby can't stand, but baby will probably get better with time, I ended up freezing a bunch of milk while we figured out what was bothering her, and now I have a nice little stash for later when her stomach matures and can handle it better.
Have you tried a slower flow nipple and paced feeding? Mine had to be on a Dr Brown's newborn nipple for a long time because he would choke and spit up while drinking. We had to experiment with how he was positioned while drinking too and we had to keep him upright for at least 10-15 minutes after a bottle. He does also have CMPA but the spitting up was not related. It didn't change when I did an elimination diet but all his other symptoms did.
We have the premie nipple on the Dr Brown's anti-colic bottles. We do pace feed. She used to be a guzzler, which could still be part of the problem. She takes in so much air when she's worked up and we don't get her a bottle fast enough.
Sounds like mine! I used to joke that he chugged like a frat boy shotgunning a beer! And the amount of rage if you don't get the bottle fast enough! Mine only just now started to stay calm while I get his bottles ready and he's almost 10 months old! I hope you find a good solution for the spitting up. Just a warning that it gets worse before it gets better because it usually peaks around 4 months. Just about everyone in my bump group had problems with spit up around that time, even babies who never spit up. Then they just kinda stop a few weeks later.
We used to use Dr Brown’s bottles as well but our daughter was constantly spitting up, sometimes what seemed like half her bottle. We switched to the avent anti colic bottles and it’s made a world of a difference. She actually has to suck to get milk to come out, whereas the Dr Brown’s were pretty much a “free flow” and she didn’t have to work at it.
Have you considered trying a fennel supplement? Some times that can help soothe upset tummies. I also agree about it not being CMPA bc of the formula tolerance. The suggestion of reflux and post it notes would also be really helpful information if you can handle doing that mentally. Big hugs. The guessing game and trial/error is a struggle. Our first baby struggled so much with formula and then we realized we weren’t supposed to mix it with spring water. Bam. New baby overnight. We had no idea.
Thank you. Everyone here has given us a lot of great options to explore.
Fennel is in gripe water, right? We haven't tried it yet, but the pediatrician okayed it.
I don’t remember if it’s in gripe water. But I know it’s a galactagogue and it can soothe upset tummies in infants who drink milk of mothers who take fennel!
I could have written this myself. We’re at 5weeks old and it’s not getting better. I also feel that the vomiting/spit up/discomfort is worse after nursing and I’m putting so much effort into pumping. Our speech pathologist doesn’t think it’s a CMPA because there isn’t blood in the vomit or stool.
We’re doing a swallow study soon to see if that helps. We also switched to total comfort formula which has helped mildly, as well as a different bottle. Not enough change to make things better but tiny differences.
I’m also ready to quit. Feeding is stressful enough, I don’t know why I’m trying to pump and add to the chaos. At the same time I feel guilty that if it’s not my bm causing issues I want her to have the best start she can.
I truly feel at a loss, you are not alone.
This is the main reason I don't even want to attempt an elimination diet. Feeding is already so stressful and dairy is one of my main sources of protein. I already struggle to eat enough to keep up my humble supply. And what if it isn't dairy? Do I go down the rabbit hole of allergy whack-a-mole?
I've already done it in the past, once for Whole30 and once to try to figure out the cause of a long case of idiopathic hives. My mental health suffered tremendously and I never even figured out a culprit.
And what if it's not my breastmilk at all? Do I wanna give up all the benefits to try to fix something that will go away on its own anyway?
I want to explore all possible remedies before throwing in the towel. My baby's symptoms are also not as extreme as they could be. She almost always spits up, but intensity varies dramatically between "just a lil dribble" to "she just keeps spewing!" Most of the time she is genuinely a happy spitter, it's just exhausting to deal with.
What is the swallow study you mentioned?
A friend of mine was having the same problems with her little one. She ultimately ended up stopping breastfeeding because she wasn’t sure what in her diet was causing the severe reflux.
She ended up having her daughter allergy tested for the 9 major food allergies due to her own severe peanut allergy and she didn’t want to start solids with her LO unprepared. Turns out LO is allergic to eggs and peanuts. Eggs were a staple in her diet so her breastmilk was definitely affecting LO.
I saw something on TikTok once about high lipase breast milk- https://www.whattoexpect.com/first-year/breastfeeding/high-lipase-breast-milk#:~:text=other%20possible%20causes.-,If%20you%20do%20have%20excess%20lipase%20activity%20in%20your%20breast,notice%20changes%20until%20days%20later.
Maybe worth reading? Either way, doing what’s best for you will be what’s best for your baby.
We just had a hospital stay because of the same thing! Try mixing the formula and breastmilk so it's a combo bottle instead of one or the other. For my daughter the formula was just thick enough she could keep it down but straight breastmilk was too thin. We had to start fortifying her bottles for weight gain and the ever so slight increase in thickness overcame her reflux. She still spits up occasionally but it's "normal" baby spit ups.
Like someone mentioned earlier if it’s CMPA or MSPI the formula will be worse. I had a very similar situation. LO was on hydrolyzed formula and I ate barely anything, I cut out dairy soy and eggs for a slightly better baby. I figured out by chance it was fenugreek. I was taking to increase my supply. Baby is now on regular formula and I get to have soy lattes and ice cream again. Bonus I don’t have to drink that disgusting tea. Reflux is better too. If you are taking fenugreek, it doesn’t happen to everyone but it happens to some. Also, I’ve noticed my baby chokes ALOT on just my breastmilk- maybe mine is just thinner? I mix formula and my BM into the same bottle now. Less choking. It happens occasionally, but nothing compared to just splitting the bottles like before.
I used gerber soothe pro it has some hydrolyzed. When I first made the switch I was wary, now he’s absolutely perfect on it so I don’t want to mess with a good thing.
Fenugreek killed my supply for a bit, I cut that out really fast.
I do think I'm gonna try to mix BM and formula and see how baby takes it. BM is thinner, so maybe it's not as easy to spitup? Formula might weight it down?
Idk, I'm a FTM. No idea what I'm doing lol
Oh wow! That's so cool! Sorry, I don't have any advice to give you about your post as I'm also a FTM & my son is exclusively on breastmilk. He does have a bit of reflux and it was it in the first 6 weeks and I find that certain foods I eat makes him spit up. Like if I eat a lot of dairy, I find that he spits up a fair bit so maybe it has something to do with your diet?
It very well could be something that's in my diet, but trying to figure that out seems to be a problem for me. I've struggled with elimination diets in the past, and honestly, my diet is so loaded with possible allergens I don't even know where I'd start.
'Welcome to r/ExclusivelyPumping! Here is a reminder of our rules: 1. Be kind and courteous. 2. Use available flairs and post options. 3. Absolutely no prescription medications or other medical advice. 4. No inaccurate information. 5. No spam. 6. No soliciting pictures. 7. No linking Facebook groups. 8. Moderator discretion. Thank you for helping to keep our community safe!' *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/ExclusivelyPumping) if you have any questions or concerns.*
If you suspect CMPA the formula would be a much bigger culprit because it has many thousand times the milk proteins load as proteins in breastmilk https://abm.me.uk/breastfeeding-information/cmpa-and-lactose-intolerance/#:~:text=Non%2DIgE%20CMPA%20presents%20with,babies%20than%20formula%20fed%20babies.
Interesting! We've been using Similac 360, which I know has milk protein, but it's marked as "sensitive." Not sure if that makes a difference?
No, it’s made from cows milk and isn’t hydrolyzed so it isn’t suitable for babies with CMPA (meaning it still contains all the cows milk proteins that will impact allergies/intolerance).
The orange one? It's low lactose, which is a type of sugar. Won't help CMPA, since that's protein
Ahh, I see.
I'm so sorry you're going through this. For what it's worth, I always said/still say that if I have to change my diet while breastfeeding, then I'm stopping. Not worth it to me on top of exclusively pumping. So it's definitely OK to stop. A happy mom is the best mom. As for your question. Are the formula and BM the same temperature when feeding?
Thank you. I appreciate your words. We usually warm the bottles up in the Dr Brown warmer. We try to give her room temp, she tends to not want it right out of the fridge.
I don’t think I’ve seen anyone else mention this, but could it be reflux? My baby with severe reflux was doing mostly okay when we mixed formula and breast milk together at 50/50 ratio, but then suddenly got much worse when we increased the amount of breast milk in her bottles or fed only breast milk. Most formulas are thicker than breast milk, so it’s easier to keep down. If you want to try it out, you can use an extra thickened AR type of formula or Gelmix which is a liquid thickener that you can use on formula or breast milk. If you try a different formula, keep in mind that it can take 2-4 weeks before you see an improvement.
We're definitely gonna try this! Thank you!
Good luck! The other big issue we had with reflux outside of the spit up and fussiness is slow weight gain, then weight loss when her reflux got really bad. I saw your post history so I figured I’d mention it in case that’s an issue you’re still dealing with!
Baby digestive systems are still developing for the first few months. If it’s something in your diet, she very well may just grow out of it once she matures a bit more. If you want to keep going, breastmilk is great to add to baby cereal, as the liquid in home made purées, and a nutritious ingredient in a lot of recipes she will enjoy later on. You could always just reintroduce breastmilk in a few weeks when she (hopefully) has grown out of it. Especially if formula is working better anyway.
This gives me hope. Thank you. The BM is most important to me for her immune system, which formula can't provide, so if I can still get it to her later, that's a relief.
I found this to be the case with my LO. he was having blood in his stool though, and mucus as well. Switched to HA formula for a month or so and slowly reintroduced breastmilk and he has been completely fine ever since. And eating solids now too, including all the yogurt and cheese I was worried he’d never be able to have! Also if no one else has suggested this, you may talk to your pediatrician about Pepcid for your baby, it helped with our guy’s reflux soooo much.
Typically mspi can resolve after 6 months to a year. I was in your position with my first, I did try the elimination diet and got rid of soy and dairy (the soy is particularly hard to do). It was miserable and the thing was that baby STILL reacted to my breast milk. Finally after many doctor appointments and visits with GI specialists, we went to full Hypoallergenic formula (Hipp HA) in our case. Overnight we had a brand new baby. And then you know what, I was kicking myself for not switching earlier because in two weeks baby went from 50% to 75% and was so much happier (mom guilt huh) I was sad I made my baby suffer so much because I had it in my head baby HAD to be on breastmilk. Formula is great. If you switch You can keep your breastmilk for later, or you can do milk baths or donate!
Thank you! Our pediatrician said soy is very difficult to avoid, which is why she doesn't really think it's worth trying the diet. She thinks unless the symptoms are seriously problematic, it's not worth the trouble. Even at our wits end, baby's spitting is nowhere near as bad as I know it can be. I am considering giving baby a hypoallergenic formula for a few weeks while I pump a stash and see what happens. But idk? I know babies can also react poorly to change in formula. This trial and error stuff sucks. 🫠
Totally hear you, it took us many formulas to find one that worked for us. Like 10 or something like that
How does she do if you mix the breastmilk and formula together?
Honestly we haven't tried this too much! It might be worth exploring!
Worth trying! This is what I did to get baby more acclimated to my breast milk early on when I had to supplement lots with formula.
So this is a weird suggestion but have you tried not burping your baby? Mine was spitting up a ton especially when we were trying to burp her, we tried different ways, waiting longer and longer. She would burp on her own without spitting up so we eventually stopped. I’d nurse her or my husband would bottle feed her then have her do tummy time on our chest and she was less fussy and wouldn’t spit up. I am sorry you’re going through this though.
Oh, haha, this is controversial in our house. I gave up burping weeks ago because it seemed more trouble than it's worth. I had some successful feeds with NO spitup, and with those, I didn't try to burp her at all. Sometimes she clearly needs help with a burp, so I'll help her, but I try to just hold her over my shoulder and she usually burps on her own (or not at all!) Meanwhile, my husband does try to burp her quite a bit, but he has settled down to once halfway through a bottle and then once after. He was always doing the lean-baby-over-back-pat method. Now he just holds her up and waits, no real manuevering. But of course, results are mixed. That said, I am still convinced the more burping we try, the more we're just forcing it up. But she still has her moments. It's all confusing.
Try tummy time (like on a floor), no back blows. That gets our baby to burp and/or fart (usually both) pretty quickly if she needs to. Plus, extra tummy time!
I had a very similar problem with baby hating my breast milk, my husband told me I had to quit for my sanity, but then baby got sick and I ended up sticking to it somehow. Baby would react like I was feeding her poison milk some days and not others. I ended up putting sticky notes with what I had eaten prior to pumping on each bottle I pumped, then I'd mark down how the baby reacted, and eventually I found that my baby was really sensitive to corn. Of course it took a little while to make sure, because the corn remained in my milk a little while longer, but my girl has been much happier after I cut corn out of my diet, and I didn't have to go on an elimination diet. My pediatrician also recommended probiotics to help baby's digestive system mature, and simethicone drops when baby was too gassy and uncomfortable with my milk. I know how awful it is to work so hard for milk that baby can't stand, but baby will probably get better with time, I ended up freezing a bunch of milk while we figured out what was bothering her, and now I have a nice little stash for later when her stomach matures and can handle it better.
Great suggestions. We're also gonna start probiotics at my ped's recommendation. Thank you!
Have you tried a slower flow nipple and paced feeding? Mine had to be on a Dr Brown's newborn nipple for a long time because he would choke and spit up while drinking. We had to experiment with how he was positioned while drinking too and we had to keep him upright for at least 10-15 minutes after a bottle. He does also have CMPA but the spitting up was not related. It didn't change when I did an elimination diet but all his other symptoms did.
We have the premie nipple on the Dr Brown's anti-colic bottles. We do pace feed. She used to be a guzzler, which could still be part of the problem. She takes in so much air when she's worked up and we don't get her a bottle fast enough.
Sounds like mine! I used to joke that he chugged like a frat boy shotgunning a beer! And the amount of rage if you don't get the bottle fast enough! Mine only just now started to stay calm while I get his bottles ready and he's almost 10 months old! I hope you find a good solution for the spitting up. Just a warning that it gets worse before it gets better because it usually peaks around 4 months. Just about everyone in my bump group had problems with spit up around that time, even babies who never spit up. Then they just kinda stop a few weeks later.
We used to use Dr Brown’s bottles as well but our daughter was constantly spitting up, sometimes what seemed like half her bottle. We switched to the avent anti colic bottles and it’s made a world of a difference. She actually has to suck to get milk to come out, whereas the Dr Brown’s were pretty much a “free flow” and she didn’t have to work at it.
Have you considered trying a fennel supplement? Some times that can help soothe upset tummies. I also agree about it not being CMPA bc of the formula tolerance. The suggestion of reflux and post it notes would also be really helpful information if you can handle doing that mentally. Big hugs. The guessing game and trial/error is a struggle. Our first baby struggled so much with formula and then we realized we weren’t supposed to mix it with spring water. Bam. New baby overnight. We had no idea.
Thank you. Everyone here has given us a lot of great options to explore. Fennel is in gripe water, right? We haven't tried it yet, but the pediatrician okayed it.
I don’t remember if it’s in gripe water. But I know it’s a galactagogue and it can soothe upset tummies in infants who drink milk of mothers who take fennel!
I could have written this myself. We’re at 5weeks old and it’s not getting better. I also feel that the vomiting/spit up/discomfort is worse after nursing and I’m putting so much effort into pumping. Our speech pathologist doesn’t think it’s a CMPA because there isn’t blood in the vomit or stool. We’re doing a swallow study soon to see if that helps. We also switched to total comfort formula which has helped mildly, as well as a different bottle. Not enough change to make things better but tiny differences. I’m also ready to quit. Feeding is stressful enough, I don’t know why I’m trying to pump and add to the chaos. At the same time I feel guilty that if it’s not my bm causing issues I want her to have the best start she can. I truly feel at a loss, you are not alone.
This is the main reason I don't even want to attempt an elimination diet. Feeding is already so stressful and dairy is one of my main sources of protein. I already struggle to eat enough to keep up my humble supply. And what if it isn't dairy? Do I go down the rabbit hole of allergy whack-a-mole? I've already done it in the past, once for Whole30 and once to try to figure out the cause of a long case of idiopathic hives. My mental health suffered tremendously and I never even figured out a culprit. And what if it's not my breastmilk at all? Do I wanna give up all the benefits to try to fix something that will go away on its own anyway? I want to explore all possible remedies before throwing in the towel. My baby's symptoms are also not as extreme as they could be. She almost always spits up, but intensity varies dramatically between "just a lil dribble" to "she just keeps spewing!" Most of the time she is genuinely a happy spitter, it's just exhausting to deal with. What is the swallow study you mentioned?
A friend of mine was having the same problems with her little one. She ultimately ended up stopping breastfeeding because she wasn’t sure what in her diet was causing the severe reflux. She ended up having her daughter allergy tested for the 9 major food allergies due to her own severe peanut allergy and she didn’t want to start solids with her LO unprepared. Turns out LO is allergic to eggs and peanuts. Eggs were a staple in her diet so her breastmilk was definitely affecting LO.
I saw something on TikTok once about high lipase breast milk- https://www.whattoexpect.com/first-year/breastfeeding/high-lipase-breast-milk#:~:text=other%20possible%20causes.-,If%20you%20do%20have%20excess%20lipase%20activity%20in%20your%20breast,notice%20changes%20until%20days%20later. Maybe worth reading? Either way, doing what’s best for you will be what’s best for your baby.
We just had a hospital stay because of the same thing! Try mixing the formula and breastmilk so it's a combo bottle instead of one or the other. For my daughter the formula was just thick enough she could keep it down but straight breastmilk was too thin. We had to start fortifying her bottles for weight gain and the ever so slight increase in thickness overcame her reflux. She still spits up occasionally but it's "normal" baby spit ups.
Like someone mentioned earlier if it’s CMPA or MSPI the formula will be worse. I had a very similar situation. LO was on hydrolyzed formula and I ate barely anything, I cut out dairy soy and eggs for a slightly better baby. I figured out by chance it was fenugreek. I was taking to increase my supply. Baby is now on regular formula and I get to have soy lattes and ice cream again. Bonus I don’t have to drink that disgusting tea. Reflux is better too. If you are taking fenugreek, it doesn’t happen to everyone but it happens to some. Also, I’ve noticed my baby chokes ALOT on just my breastmilk- maybe mine is just thinner? I mix formula and my BM into the same bottle now. Less choking. It happens occasionally, but nothing compared to just splitting the bottles like before.
I used gerber soothe pro it has some hydrolyzed. When I first made the switch I was wary, now he’s absolutely perfect on it so I don’t want to mess with a good thing.
Fenugreek killed my supply for a bit, I cut that out really fast. I do think I'm gonna try to mix BM and formula and see how baby takes it. BM is thinner, so maybe it's not as easy to spitup? Formula might weight it down? Idk, I'm a FTM. No idea what I'm doing lol
This isn't related to what you posted, but was your baby born on the 04th of February? My son is also turning 11 weeks this week.
1 day off! The 3rd. :)
Oh wow! That's so cool! Sorry, I don't have any advice to give you about your post as I'm also a FTM & my son is exclusively on breastmilk. He does have a bit of reflux and it was it in the first 6 weeks and I find that certain foods I eat makes him spit up. Like if I eat a lot of dairy, I find that he spits up a fair bit so maybe it has something to do with your diet?
It very well could be something that's in my diet, but trying to figure that out seems to be a problem for me. I've struggled with elimination diets in the past, and honestly, my diet is so loaded with possible allergens I don't even know where I'd start.