I talked to a mother today whose 6 week old baby who was born at 32 weeks and
went home from the hospital in 2 weeks.  I have had contact with this mother
before, but we were out of touch for about a month (something I could feel
guilty about, but it's not going to do much good now).  Her baby is gaining
weight well.  Soon after discharge she weighed 4.5 pounds and  one month
later she weighs 7.5 lbs.  The baby did well with feedings in the hospital.
 Mom was breastfeeding a couple of times a day when she brought her home.
 Her supply was not great--she physically has difficulty pumping because her
breasts are so large, and she does not describe much of a let down with the
pump.  I have never seen the mother pump or the baby at breast.  We have
scheduled a consult on Monday.
This mother describes her baby as being very fussy--feedings are violent--the
baby jumps around, grunts and is gassy during feeds and for about an hour
afterward.  She spits up unless the mother holds her upright.  Her M.D. has
examined the baby and feels that the baby has reflux and prescribed Reglan.
   No G.I. studies have been performed.  The mother bought the Reglan, then
looked up the side effects in the PDR and has decided she didn't want to give
it to her baby.  So she holds her instead--not a bad thing, of course, but
the mother is becoming exhausted.  I suggested putting baby in a Sling or
Snugli so that she could sleep in a recliner while she's holding her and
she's going to try that.
This baby is supplemented with Neocare formula.  She was on 24 calorie
Enfamil when she came home and for two weeks afterward.  The mother is able
to pump about a third of her intake.  The problem with the fussiness and
grunting (it is not grunting with respirations) started on the ride home from
the hospital.  She is also on vitamins with iron, neocare is iron fortified,
and mother takes prenatal vitamins.
I'm wondering whether this baby has reflux, or if she does,  is it  only a
part of her problem.  It sounds like it could be an allergic response to
me--am I out of line?
If I am not, I need some guidance on where to go from here and what to
suggest.  I will know more on Monday, but I am leaving town for a week after
that, so I would appreciate any information anyone could give me before I see
her.
My questions:
   1.  if it is an allergic response, what formula would be best while we are
working on supply?
   2.  could all the iron be part of the problem?
   3.  how do we work on supply at this point?  She has an Egnell pump.  I
didn't ask her what size her nipples were, but she has very large breasts,
has only been able to single pump  because she doesn't feel she can
physically handle more than one.  Does anyone have any opinions on what brand
of pump is better for large breasts?  Does the large flange from Medela help
with large breasts, in addition to large nipples?  Anyone used White River
pumps?  She has a flexishield and felt that it didn't help, but I don't know
how long she tried it.
   4.  Oxytocin nasal spray--is there a way to make it and would it help?
   5.  She pumps as often as she can--has tried q 2-3 hours and doesn't think
it made much difference.  On good days now she pumps q 3 hrs, sometimes waits
6 hrs.  She gets 20-25cc at 3 hours and 2 oz at 6 hours.  She has to massage
a lot and never sees much of a spray.  Of course less stress would help.
    6.  She doesn't want to use Reglan, and I'm not sure it would help at
this stage of the game.  Does anyone have experience with Fenugreek at 6
weeks?
    7.  Does anyone have info on reflux that would lead them to agree that
this is resonable diagnosis?  I know i haven't given you much to go on, but
my knowledge of reflux is real sketchy--any good articles I could read, or
has it been discussed on Lactnet in the past?
Sorry to be so long--please send copy to me privately as well as to group as
I am going to have to go nomail on Mon. night
Thanks so much--you guys are great
Chris Lundberg
Indianapolis
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