Hello, Heather.
       I have a couple thoughts, none of which might be helpful, but here
goes.  You mention that baby has been refusing to nurse well since third day of
thrush treatment.  Was the milk supply a problem before that?
       If not, thrush can release toxins as it dies off, sometimes causing
quite a bit of digestive distress.  Suggest the mother drink a lot of
water--might help wash those toxins out of her body more quickly and might make the milk
more palatable to the baby.  On the other hand, it might be that the baby's
own treatment is giving him a bellyache, so perhaps short, frequent feeds might
be in order for a couple of days.  Perhaps mom could pump to finish empyting
breast and offer that hindmilk to baby in a bottle, so he doesn't compound
possible digestive upset with foremilk/hindmilk imbalance as well.  Or, perhaps
baby truly hates the taste of the milk with the thrush medicine in it!  Could
mother try a different medicine or herbal protocol to treat her thrush?
       If milk supply was a problem before thrush treatment started, then I
have a different conjecture.  (You say everything has been going well up to
this point--12 weeks--so I'm not sure when supply became an issue.)  I have very
frequently seen babies who did well for the first 2 or 3 months, but then at 3
or 4 months, did not gain well or began not being satisfied at breast.  I did
not see these moms/babies in the early days, because they thought everything
was going well, or well enough.  Then, they come to my office when the baby's
weight gain falls apart, or baby starts fussing all the time.  Observation of
a breastfeeding session reveals that baby's breastfeeding technique is not
really what it should be.  When I ask, mom says "He's always done that."  I see
it with babies who breastfeed with a nipple shield, and overworked hospital
staff was so happy to see that an arching, screaming baby finally latched that
they then took off to the next room with another screaming baby, rather than
really observing that the first baby's technique is really appropriate now that
he will latch with the nipple shield.  So, while he has been latching, his
technique has not been great.  I also see it in "martyr" moms--the ones who say,
"Well, nursing has always hurt a little, but I could tolerate it so we kept
going."  I tell new moms that, while it is admirable to sacrifice for your
children, putting up with breastfeeding pain is not the place to sacrifice.  We
*need* to figure out why the baby is causing pain and correct it, or we are
risking loss of extended breastfeeding.
       My take on why these types of situations fall apart at 3-4 months is
this:  I think that in the early weeks, for many moms, if baby's suck is
*close* to right, the hormone levels are high enough to maintain supply.  But then
at 2-3 months postpartum, as mom's hormone levels drop and supply becomes
"baby-driven", baby's incorrect suck cannot maintain adequate supply.  For some
moms, it's a gradually developing situation, but for many moms, it seems to
happen "overnight."  I think that there is some invisible threshold level (probably
set at a different point for each woman) where, when the hormones drop below
that level, suddenly there are supply problems due to baby's incorrect suck
technique.  So you might ask if mom has experienced pain with nursing all along.
 I would suggest watching a feeding, but baby is being uncooperative about
that right now.
       Another thought is about ear infections.  Perhaps baby has developed
one quite recently.  They can develop overnight, so even if baby went to dr.
last week, it could be a problem now.  If baby willingly takes a bottle of
formula, perhaps it's because his ears are level for bottle-feeding.  Whether mom
sits baby upright or lays him back on her forearm, his ears are usually level.
This is not the case in cradle-hold breastfeeding.  In case his ears are
bothering him, you might suggest that she sit him up, facing her and straddling
her leg, and offer to nurse him in that sitting up position so any fluid in his
ears won't put pressure on the eardrum like it will when he is laid on his
side.
       Is mother pumping, with a good pump, to maintain/rebuild supply?
       Hope these ideas help.
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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