Dear Sue,

Here are some resources which may help. My thoughts seem to hover around the suctioning to clear airway which can cause severe oral aversion in new borns and the use of bottle for feeding the baby. 

Oral Aversion in the Breastfed Neonate - http://www.llli.org/ba/Aug00.html - "Oral aversion and the potential for maladaptive imprinting are rarely discussed in conjunction with infant feeding and newborn care. However, in many cases the development of oral aversion can be prevented. One of the most common practices newborns encounter immediately following delivery is suctioning of the airway. NICU nurses have identified suctioning as noxious and possibly painful because it involves potential tissue damage and often elicits responses that resemble pain."

Some helpful suggestions are discussed in http://www.llli.org/NB/NBJulAug01p136.html Sometimes if the baby seems settled on a bottle nipple a slow transition to the breast with lots of skin-to-skin contact along with temporary use of nipple shield may help.

I hope that helps.

Take Care

Yasmin
LLLL

________________________________
From: "Sue Petracek, IBCLC" <[log in to unmask]>
To: [log in to unmask]
Sent: Thu, 28 January, 2010 8:07:15
Subject: screaming baby

I'm hoping someone can help with a mom and baby I saw this afternoon. This is mom's 4th baby, has breastfed all and is very motivated to breastfeed because this is her last baby. Relatively short, uneventful vaginal delivery; baby had suctioning to clear airway. Baby seemingly nursed fine in the hospital and at home until mom's milk came in. Baby is 1 week today; 39 weeks gestation at birth. 
Mom has large breasts, flattish, undamaged nipples, but baby is able to latch and suckle briefly. Then baby pulls off, screams furiously but without arching. 
Mom's milk is abundant; she is easily able to express drops to start the process. So I don't think this is a baby who is just impatient for the milk to come. 
Mom doesn't seem to have a strong let-down since there is no spraying or leaking when baby comes off the breast. So it doesn't seem like the flow is overwhelming the baby.
Baby's suck seems fine. Her tongue extends forward well and cups finger with oral exam. When she is crying, baby is a little slow to respond to the touch of my finger or a bottle nipple on the roof of her mouth and thus difficult to settle. But once settled she takes finger or bottle nipple easily. We tried different positions, always with the same result. At home mom tried a reclined, more upright position for baby with no difference.
Mom has been pumping and feeding baby with a BreastFlow bottle. Baby takes bottle well without fussing or crying at all. She's back to birth weight at a week. So this behavior doesn't seem to be a reaction to mom's milk or something in it.
I'm stuck. I keep thinking this cry is not a fussy or hungry cry; I think it is pain. I keep going back to the suctioning right after birth. Perhaps there was some injury there that didn't reveal itself early on because colostrum feeds didn't irritate. But then it seems like all feeds would generate the pain, not just feeds at the breast.
What am I missing?

Many thanks,
Sue



      

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