Hello, wise and experienced ones:  I saw an 8-day-old baby for the
first time today who has me somewhat puzzled.  Born at 41 weeks with
normal pregnancy, NSVD, latched and nursed fairly well (the mother
couldn't tell me what, if any meds, were given but no epidural at any
rate).  After mom's milk came in and she was slightly engorged, the baby's
latch and suck went downhill, and apparently by day 6, she had lost 12% of
birth wt.  Right from birth, she was only feeding every 3 hours and
difficult to wake for feedings.  The mom had become discouraged at her
poor latch and suck, and had pumped her milk, giving the baby 1oz ebm by
bottle per feeding. Bottle feedings apparently went well per mother. The
LC saw her, felt that she had possible inverted
nipples, and had her finger feed baby with SNS.  The mother
began to breastfeed with SNS for 20-30 minutes, then following up with
finger feeding, and was now getting 2 oz when pumping.  Baby was stooling
with every feed (greenish mustard), and having adequate wet diapers.
Today she was back to birth weight. Mother has not used abm.
The mom does not have inverted nipples.  She has a bountiful milk supply.
The problem is the baby can barely be woken up to latch and when she
latches she barely even tries to suck.  With the SNS, she took in <1/2 oz
over a 20 minute period, and finger fed another 1 oz. over another 30
minutes.  This occurred about 3 1/2 hours after her last feeding.  Baby's
palate felt normal, the tongue came forward past the gumline.  I'm not
that experienced with suck assessment, but her tongue die not feel as
though there was a coordinated peristaltic front-to-back movement.  The
baby was apparently checked by her pediatrician and found to be otherwise
healthy (I could not examine her as this was a contact at a support group,
not in my office).  I will have the mother get the baby reassessed for any
medical problems, although she looked healthy.  She didn't
start out sucking well, then tire out.  She was just too sleepy to
nurse from the start.  The mother was waking her because it had been more
than 3 hours, and has been pretty much having to wake her for feedings
from birth.
Since the baby is gaining well, I don't see this as the sleepiness of poor
intake.  She's term and appears otherwise healthy, so why is she not
exhibiting any interest in feeding?  This mother is finding the long
feedings and the lack of progress in feeding effectively at the breast
frustrating, and she has a rather unsupportive m-i-l who keeps saying she
should be giving formula.  She will keep trying if she hears enough
encouragement that this baby could turn around and breastfeed in the next
few weeks.  I will try to determine what meds she had in labor, and make
sure that baby gets checked for underlying medical problems.  If neither
of these is an issue, do any of you have other suggestions?  Stories of
babies with this kind of behavior who perked up and nursed well?
TIA, Alicia Dermer, MD, IBCLC.