I was hoping for some wisdom here.

Hx:
Mathew 24 may 2003
Delivered Vaginally 4510g
Nitrous gas used for pain during delivery
No forceps, no vacuum
Initially good latch
Fed q hourly during the day
Fed q 2 hours at night

5 weeks started to refuse feeds.
Could get him on an latched initially but got worse and worse
At three months got better for some reason nothing different in strategy
Lasted two weeks
Returned to same pattern of refusal.

Sleep pattern:
Naps: sleep in after noon for a couple of hours.  AS a rule will not sleep
other times.

Night:
At 9 weeks started self sleeping for 8 hours, then he stopped putting on
weight, Rose woke once in the night for feed, still no weight gain, then
woke twice in the night now he is self waking twice in the night.

9 weeks  weight 7200g.

Weight gain pattern:
1st week lost 3oz
2nd put on a pound
350-500gms every week until 9 weeks old.
9-12 weeks he only put on 200 grams.

21 Weeks Weight 7780.
580 g weight gain over the past 12 weeks.  Last week lost an ounce.


Mom frustrated with feeding and concerned over weight and sleeping
pattern.  She is getting very little rest during the day as Mathew fusses
if she stops moving or is not paying attention to her.
If really upset and then falls asleep will feed well but when alert
struggles and wiggles and fights to feed if Rose tries to long he will
start crying.

Moms diet
5 weeks no dairy products from 3-8 weeks started because he was feeding so
often and didn’t seem to settle no effect.
Eliminated wheat products for 3 weeks with no result.
Has read a book about fruit and is now trying a week without fruit to see
if there is an impact.

Poo’s
2 poos a day until 9 weeks old
9 weeks suddenly changed to once a week
don’t believe that poos where smelly when putting on weight.
Now smelly and flecks of white and undigested particles, sometimes “watery
like a yellow stain”

Urine:
4-5 disposable nappies in a day


Family History: 2.5 year old Daughter:
Supply problem frustrated without immediate let down.
Had to feed in a low stimulus room for one year.
Mom feels is it is a similar problem but not exactly the same


Observation:
Bright eyed,  active,  appears to be thriving with the exception of the
weight gain pattern.
Feeding, latch on well and feeds for about 10-20 seconds, will pop off arch
then fling himself back on the breast.  Active swallowing heard, but seems
irritated and discontent when not actively feeding.  Feeds only seem to
last about 1-5 minutes but when they were leaving Mathew appeared really
hungry even though in the hour he had been here he had fed about 4 separate
times similar to what was described before.  Rose stated that the feeds he
had when he was with me were actually quite good for him.
Rose states that Mathew Snacks every few hours now. Feeds range from a few
seconds to ten minute feed, he feeds better when he is sleeping will feed
for about 20 minutes.  The two night feeds are his best.
During the day he only sleeps for a few hours in one period and remains
wriggly and active and requires constant motion from his mother to stay
contented.  I suggested she try a sling and see if this helped her handle
both his needs,her needs, and her two and a half year olds.
When Mathew is not feeding he is laughing and responding and appears
neurologically appropriate for his age, excellent muscle tone, there is
nothing obviously physically wrong with him.

5 weeks would choke when there was a let down. Wriggly pulling off - mom
feels they are unconnected.  Feels refusal is related to pain and hunger,
Swallows one time then seems upset by it but not always.  I thought it
might be possible that Mathew possibly learned some coping techniques
during a period of overactive let down that happened around 4-5 weeks.
Then I think that Roses supply may have dwindled and now he is frustrated
at the breast, but I am not entirely convinced, and also not entirely sure
how to fix it.  Does anyone out there have any other ideas.
Cheers,
Mandi Porta RN, IBCLC

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