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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