I wonder if this baby has had a bad experience at the breast - maybe 
someone (the mother?) pushing his head, or insisting on him feeding 
by continuing to stimulate him to get him latched, between days 3 and 
5?

Then, after refusing on day 5, the tension is increased becase the 
pushing and insisting probably increased.

In my experience, too many interventions to try to 'fix' the problem 
can be counter productive.  I am assuming the baby is well-nourished 
and thriving.

Pumping and bottle feeding at the moment are *fine* - that's what the 
mother has found is at least a way to get milk into him, and she can 
certainly continue with this, at the same time as *gently enabling* 
him to come back to the breast in his own good time, in his own way.

I usually suggest co-bathing in these situations. Just let the baby 
and the mother enjoy the closeness and warmth of the water, and the 
baby can come to the breast *if* he wants to.  Skin to skin ad lib 
the rest of the time, baby and mother snuggled into bed together, 
with no pressure.

More,  and more complex,  interventions are not warranted at this 
stage, so I would definitely not be suggesting any sort of therapy or 
treatment at this time....give everyone time to calm down and 
rediscover each other :) Obviously if things get worse or don't 
improve after another week or so, then think again.

I wonder why this baby was given formula on night 2 and night 3? Was 
there some fussiness that someone (HCP? mother?) thought would be 
fixed by a bottle? He won't have *needed* the formula,because if he 
was not transferring colostrum she could have hand expressed. So the 
formula was unnecessary and served no justifiable clinical 
purpose....but it has undermined this mother's confidence and 
probably increased her worries and tension.  How much better things 
might have been if formula had been avoided.

Hope this helps. Would be v. interested in what others would do.

Heather Welford Neil
NCT bfc, tutor, UK




>I tried checking the archives (I admit being a bit inept at that) 
>but didn't find the answer I was looking for. Hope someone can help. 
>PTP.
>
>I am working with a Mom and her 7 day old baby. Wonderful, 
>uncomplicated, unmedicated , first birth. Mom breastfed in delivery 
>room. Separate for a number of hours but then breastfeeds continued 
>until night 2 and night 3 baby received one bottle of formula each. 
>Weight loss of 9% at discharge. "All was fine"  until night 5 - baby 
>started fussing and refusing breast. Day 6 baby fussy all day and 
>crying when trying to latch. Baby would eat a small amount (by time) 
>and fall asleep, then cry and try again. By night 6 baby was 
>screeching and screaming when put to breast, even as nipple was in 
>his mouth. Fell asleep without eating , woke short time later and 
>repeated the process.  Finally gave bottle which he gulped down and 
>fell asleep. Day 7 was a bit better , less screeching but still 
>refusing. I came late day 7 in the evening, found peacefully 
>sleeping baby. Mom picked him up and as he reached the breast he 
>started screeching (the only word I can use -it wasn't just crying!) 
>Tongue does not pass the gum line consistently but I don't feel any 
>bump or unusual frenulum under the tongue and it is all quite soft 
>and flexible with a low wide palate. No asymmetry, tone seems 
>normal. We discussed recent changes of diet,  soap, deodorant, 
>creams, etc - all negative. No oversupply, was temporarily mildly 
>engorged on day 3-4 and supply normalized quickly. Leaks when baby 
>ready to breastfeed. Nipples are sore but not excruciatingly painful
>
>I tried the following positions and interventions: football , laid 
>back - self attach, cross cradle ,standing - with and without 
>bouncing,  no hands, swaddled, naked, bait and switch,  in various 
>combinations. He did calm down when swaddled and "shushed" , but 
>would not take the breast. Finally tried nipple shield and flow with 
>tubing and syringe and he ate and fell asleep.  Mom could not 
>reproduce these results at the next feed and they are pumping and 
>bottle feeding. Mom is totally exhausted and I am afraid I was a bit 
>over zealous and continued to try to latch baby even after she could 
>not cope.  I did ask her if she wanted to stop the session , and she 
>insisted that she wanted to succeed to nurse him but by the time I 
>left she was totally drained.  Should I have just had her finger 
>feed or bottle feed?  If it was reflux/sensitivity  related wouldn't 
>the bottle also be problematic? Would body work be appropriate even 
>though there are seemingly no signs (long or complicated birth, 
>trauma or asymmetries) that indicate that this might be needed. 
>Would it be appropriate to release the tongue even though it is not 
>"typical" (it indeed does not lift or pass gum line -perhaps it is a 
>tightness that cst would release and not actually ankyloglossia 
>proper)
>What am I missing?  You might have picked up that I am not quite 
>sure what I am looking at here and how to porceed.  Any insights??
>Thanking you in Advance,
>Riva
>
>
>Riva Weissfish BA, CCE IBCLC
>Childbirth Education, Lactation Consulting, Parenting Workshops
>[log in to unmask], Cell:972527176093   Fax :97226512139

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