Dear Lactnetters,
 
       I have been just lurking so far, but now I have a case I would like to ask your advice on. 
But first of all let me briefly introduce myself. I am a psychologist. I recently applied for LLL Leadership and also would like to take the IBCLC exam. I am a happy mother of three kids, two of them tandem nursing. I mainly do counseling via internet, e-mail and telephone.

I posting this with the mother's permission. The mother is a primipara, the child was born full term with 4 kgs.
Ever since birth in every 2 weeks they had a couple of days when mother's milk supply seemed to decrease greatly from one feed to the other. The baby became fussy as well. They survived these days with very frequent nursings occasionally giving baby previously pumped and frozen EBM with a spoon. But this returned in every two weeks. She didn't mention any nipple pain. The baby was a slow gainer, average gain being 100 gr per week, but the mom says she was also petite as a child. The mom weighed nursings at this time, and about 800-1000 gr milk was consumed by the baby per day. Every now and then the baby went through a nursing strike as well crying at the breast or only wanting to accept one of the breasts (sometimes the right, sometimes the left one). But they somehow managed through all these.
The real problems started about 3 weeks ago, when this decreased-milk-days didn't seem to go away as other times. The baby became more and more fussy, crying at the breast. Weighings showed less and less milk transfer. Mom tried nursing in a neutral environment with very little stimuli. breast compression, applying anaesthetics to baby's gum thinking it's her teeth but all to no avail. Now the baby doesn't gain any more. She can be breastfed only when asleep, otherwise she starts crying as soon as she sees the breast. Wouldn't latch-on at all. Mom gave EBM 2x from a bottle, but stopped this for fear it's going to confuse the baby. The baby did take the bottle and feed from it normally. They tried co-bathing and lots of skin-to-skin and being around the baby half naked without persuading her, but she gets really-really upset, when getting near the breast. She also doesn't sleep well at night. 
The baby has been seen by two doctors recently, one of them an IBCLC. They didn't find anything unusual in the baby which would show any sign of illness. Latch couldn't be evaluated as the baby wouldn't latch -on. They are scheduled for a blood and urine test. 
Mom is really committed and is willing to try anything.
TIA for any ideas.

Eszter Schneiderne Dioszegi
Hungary

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