I would welcome suggestions on how to tackle this baby.
Born Friday evening after long labor with 6 hrs pushing, no epidural or
narcotics, vacuum rotation (was sunny-side-up) and extraction. Scalp
bruising. First Apgar of 4, resuscitation, blow-by oxygen.
Since then, a good-looking baby with good muscle tone, quite calm and alert
when not hungry.
I never saw him breastfeed in hospital but he was reported to do so, though
not for long sustained stretches. Good bowel movements and urination in
first 24 hours. Discharge Sunday, circumcision Monday.
Feedings deteriorated (? don't really know for certain they were ever
actually good) throughout Sunday and Monday, culminating in Monday evening
when the mother brought him for a consult and he did not latch at all. He
cried, occasionally allowed the breast into his mouth, then let go and
cried some more. Some rooting and hand-chewing, but he did not open wide
or extend his tongue to latch on. (At other times, he can do
both.) Palate feels normal, tongue has good mobility and extension,
mother's nipples/breasts are not unusual. He acted as if he couldn't feel
the nipple in his mouth. Eventually I tried a nipple shield, experimenting
with both standard and newborn small sizes. He latched on the standard
shield but acted frustrated with the newbie one, almost like on the bare
breast. On the standard shield his latch was too tight, but we could tweak
it to be pretty much okay by rolling his lower lip, drawing his chin down,
etc. The shield gets him on the breast and suckling (apparently by
stimulating his palate), but he still suckles poorly and remained hungry --
not entirely sure if this is because of his goofy technique or also because
it was only day 3 and mom's supply wasn't huge yet. (She did hand-express
drops of colostrum readily, the shield had pooled colostrum in it whenever
he came off, and she expressed a few ccs into a cup for him.) She bought a
Medela pump today and the plan for tonight (Tues) is for her to feed at
breast (w/shield) for around 20 mins, then pump 15-20 mins and cup-feed
(which he is quite good at); the total time will be less than she has been
spending at each feeding session and will hopefully get a good deal more
milk into him. Next visit is Wed. AM.
Is this a baby who should actually be bottle-fed his supplements? Or using
a finger-feeder? Is there likely damage to the nerves? If so, what
therapies might help? Is this likely to gradually resolve as he gets over
whatever is ailing him (and starts to get enough to eat!), or should we be
prepared for a really long haul?
Elise
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