I've had quite a week.  Several problems I can't seem to help, and a couple
I could.  Thought I'd post an update on some I'd asked her before on, and
see if there are any new ideas!

First, the miserable baby (colic? oversupply? reflux?) that I've been
dealing with.  She is now 3 mos, and miserable all day long.  She fights
feedings of any kind, and even when mom switched to half breast and half soy
AIM, she's still miserable and doesn't take a bottle any better than the
breast.  Her growth is normal, not rapid, and she is a petite baby.  She
feeds well the first feeding of the morning, than is miserable all day long,
crying most of the day, and arching and struggling through every feeding.
She sleeps 8-10 hours at night, though!  We are trying now a proton pump
inhibitor, no more soy, chiropractic, and the 5 S's more aggressively and
all together.  Mom has tried a full dairy elimination and most other
techniques to calm a crying baby.

Second, the high palate/short jaw baby.  I saw him in the office on day 6 of
life and he was gaining fair.  He also struggles at the breast though.  He
refuses to latch without a shield, and struggles with the shield.  His suck
seems much better coordinated than it did the first 2 days after birth.  I
thought maybe we were on the upswing, and the mom is patient and persistent,
so I encouraged her to continue with the shield, pump some for insurance,
and avoid other nipples.  She called yesterday, though, to say baby has
gotten much fussier at breast, often seems still hungry after feeds, and she
is at her wits end.  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.  I'm trying to get her to see our wonderful
lactation consultant at WIC, but don't know if she'll go.  This family has
serious financial issues, and I know at least part of the motivation to
breastfeed comes from worrying about being able to afford AIM.  I'm hoping
we can still get this baby at breast.

Then, my friend who is pumping for her neurologically impaired son with a
G-tube hit a real low.  He is 3 mos old now, and her supply has been
supported with Reglan for over a month.  Whenever she tried to wean or stop
the Reglan, her supply tanked.  Unfortunately, she has also started to
experience pretty serious depression.  OF course it may be due to the stress
she has endured with baby's birth, subsequent hospitalization, and special
needs, but I don't think the Reglan helps.  I found a local pharmacist who
had a supply of domperidone (for her personal use actually, for its intended
use)  She hasn't needed it for a while, and gave it to me for free!  I gave
it to the pumping friend, and she switched from the Reglan.  After just 3
days, she's feeling less depressed, and her milk supply is staying stable.
Her little family also has very serious financial struggles right now, so
there is no way she could afford to buy more domperidone, but I'm hatching a
plan for that, too.

Finally, yesterday morning our office got a desperate call from a mom with a
tongue-tied baby.  She'd seen a lactation consultant at her delivering
hospital (not mine) who noticed the tight frenulum who recommended she see
her ped.  Her ped is one that I cover for frequently, who doesn't believe in
clipping frenulums.  However, this time, the ped told the mom that I might
be willing to do it!  I had her come after my office hours, and sure enough
the baby, now 15 days old, had a very tight frenulum.  The mom had already
received some excellent help with sore nipples, positioning, and
encouragement, and she felt she'd done all she could to optimize
breastfeeding, but that baby just wasn't capable of sustaining a good latch.
 I explained options, mom agreed to clipping, a few seconds later baby's
frenulum was clipped and baby back to breast.  The mom couldn't believe the
difference!  Baby latched comfortably for the first time ever.  After she
came off the breast full, this little one kept sticking her tongue out as
far as it would go - almost like "Hey, look what I can do now!"  So nice to
have a simple problem and a nice, quick intervention that provides a good
outcome!  I gave her a copy of our LLL upcoming meetings, and hope to see
her there, too.

So that was my week in breastfeeding.  Any ideas on helping the first two
kiddos is greatly appreciated!

Jennifer Tieman
Family Physician
Mom to 4, including my toddler nursling Caroline Rose

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