I’d like to ask some advice and opinions in this case:

Mother of 6 week old baby, fifth child (all under 7 years old), did not bf first three, bf fourth for 18 months and fell in love with bf. Is referred to me with baby refusing breast most of the time, and milk supply dwindled. First 4 weeks bf exclusively, was told by nurse “no problem” even tho baby stooled every 3 or 4 days;  did not re gain birth weight until 4 weeks. At four weeks began to supplement, shortly after that  baby began to refuse breast, mother began pumping, bottle feeding with supplemental formula. Currently pumping less than half of what baby needs;  says baby succeeds in latching and “feeding well” about once every couple days. 

So far, fairly common (yet difficult) situation.


When I saw her, we got baby latched on for brief minute, then pulled off and fussed. Tried using lactation aid to get baby to stay on, stayed on a couple minutes longer but still pulled off and fussed. The only thing that got this baby to calm and stay latched on for more than about one minute was when the mother stood up holding baby, rocking him fairly vigorously while standing up, and this way getting him on the breast. As soon as she stopped moving, baby fussed and cried and pulled off breast.


To increase supply, I’m trying to get her a better pump and to pump more often (currently using one of those inverted nebulizer things only 4 or 5 times a day), trying to get prescription for  domperidone.   I’m puzzled about the latching. It her case it won’t work to try alternative feeding method other than bottles. Too many hassles with home situation, motivated as she is. (They live in a tiny two-bedroom apartment, very sparse living conditions). She will use the lactation aid, tho that didn’t seem to work either in helping baby stay on.  


What about taking a break from even offering the breast, so the baby can “forget” the association with fussing at the breast? Or to keep trying? Or is this hopeless nipple confusion? She can’t stand up every time she wants to nurse him. I suggested lots of skin to skin, (not too practical with all other kids around and ultra orthodox home; maybe only at night) attempting to nurse while baby is sleepy (she has tried, appears not to help much), and to stop trying as soon as baby fusses and cries. 


Then there’s the possibility that she missed out on that crucial time for building a supply in the first weeks?


Comments, suggestions?



Yael Wyshogrod IBCLCRechovot, Israel

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