Jennifer writes .... 

> First, the miserable baby (colic? oversupply? reflux?) ....
> She is now 3 mos, and miserable all day long.>>  

When did this start? If new behaviour, for this baby how about 
mother stops trying so hard. Sometimes when the emphasis comes 
off baby taking a "good" feed (as mothers will often convey while 
physically holding baby's head to the breast ) the baby will resume 
happier feeds. It's almost like a nursing strike situation and given this 
baby is growing OK there's probably no need to panic if the mother 
tries to feed baby on baby's terms not hers. 

The discussion about developmental changes around this time may 
be helpful too. It seems mothers at 3 months have become so used 
to their baby's early pattern of being fed and comforted at the breast 
that they fail to see the baby has moved on and may want to look 
around, chuckle and "hang out" before eating or baby may want to 
eat quickly and erratically. An 8-10 hour sleep at night further makes 
me wonder if this mother has the problem rather than her day-time 
fussy baby. So, colic? oversupply? reflux? maybe - maybe not.  

Years ago a speaker talking about allergies said in his opinion colicky 
babies tend to have colicky parents. Obviously a huge generalisation 
but I do see this from time to time where parental expectation is 
through the roof and breastfeeding is so pathologised as to fall 
victim.   

> Second, the high palate/short jaw baby.....baby has gotten much fussier at
> breast, often seems still hungry after feeds,....Babe is 2 weeks old.  She is pumping most feedings now and
> feeding ebm in a bottle.  Unfortunately, she only has a single
> handpump, and her supply is waning. > 

EBM bottle seems a good thing to be doing right now to keep feeds 
contained and positive. Although money is an issue an electric breast 
pump may help mother master breastmilk feeding before tackling a 
new stage (eg. IBCLC for re-latching). If mother feels good about 
EBM feeding, importantly, under her control, the breastfeeding goal 
is less likely to move into the "too hard basket".    

Jennifer, your friends and patients are so lucky to have you as their 
breastfeeding-friendly doctor.

Marcia Annandale, IBCLC, LLLL, Christchurch, New Zealand

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