Hi All,
I have a very tough case, and am wondering if anyone has any input that
might help this poor mom.
Baby is 4.5 mos old. Was exclusively bf for the first 2 mos, mom had
very generous supply, baby gained about 2 lbs per month. At 2 mos, mom
considered going back to work and tried to get the baby to take a
bottle, and baby refused. They tried to force the issue, and baby shut
down and refused to eat at all.
For 2 months, mom breastfed this little one in her sleep, for a few
minutes during the beginning of each nap. She had to move in with
relatives, because baby refused to fall asleep for mom, so grandma got
really good at walking baby to sleep, and handed her over to mom to feed
for a few minutes. Finally, baby began to refuse even in her sleep.
When I saw this baby 2 weeks ago at 4 mos of age, she had refused to
feed, even in her sleep for the 15 hours pervious to our consult. She
looked well nourished, well hydrated, and happy, until mom held her in
a feeding position, then she arched her back and screamed. The only
remarkable feature I could see on the baby was a posterior tongue tie
that reduced her ability to groove the tongue, and postulated that the
milk flow from mom's generous supply might have been scary, and the
faster bottle was the last straw for the baby. Mom was concerned that
the baby might have an oral aversion, but she happily chewed on my
gloved finger and a vibrating teething toy that I brought along (First
years vibrating teether - I like to use this when a baby seems to have
oral aversion or to stimulate the tongue and lip muscles in a low tone
infant, and it's great for distracting an older baby who is reluctant to
breastfeed, especially the version with a rattling spinner on the bottom!).
So, we tried unusual positions (baby on the floor with her baby gym
hanging above, and mom laying on her side topless while distracting the
baby with toys) and she latched twice that way, and once she self
attached in prone on mom's bare chest while mom reclined on the couch.
She seemed to pace well and seemed perfectly happy.
Baby latched every feeding with these distraction and self-attach
techniques for 4 days, then started balking again, and after another few
days of on and off feeding, refused again. I encouraged mom to back
off, and just try self-attachment. This resulted in a return to feeding
50% of the time for 24 hours, and now she's refusing again. This poor
family, they were ecstatic that the problem was solved, now it's
difficult again.
They are going to see my favorite Pedi surgeon/IBCLC next week, as soon
as she comes back to town to see if a frenotomy will help (it did in a
similar but less severe case). If that does not help, we are going to
try other feeding methods (bottle, fingerfeeding, spoon, etc) to see if
there is some way to get food into this little angel that she will accept.
She shows no signs of reflux, though the pedi did give her a trial of
medication, which mom used only twice since the first time it upset the
baby, and the second time she vomited it. She has not seen a
gastroenterologist, which I would recommend if she does not get help
from a frenotomy.
Any wise ideas?
Thanks,
Catherine Watson Genna, IBCLC NYC
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