Lisa Marasco is on vacation, so is probably not reading lactnet this
week. She needed a rest after finishing her and Diana West's new book on
milk supply issues. (It's gonna be great!).
It seems that the two problems here are not related. Mom's hormonal
issues are not keeping her from making milk, and baby does not have more
difficulty with flow in the early morning. I would be hesitant to treat
the hyperprolactinemia unless it is very high. Prolactin is only
permissive of milk production, it is not linearly related to milk
volume. Either one has enough prolactin to make milk, or not. Higher
levels of prolactin are generally not associated with oversupply, though
pushing prolactin by giving domperidone or very frequent pumping does
help increase milk supply.
The big issue is the baby's poor endurance for feeding. Is mom willing
to give short, frequent mini feeds, and not try to make the baby
continue feeding once he is stressed? 2-3 oz 10-12 times a day should be
enough. If feedings are more relaxed and pleasant, mom might be more
rested feeding more often than struggling for a long time fewer times a day.
If mom's flow is fast, sometimes using a thin silicone nipple shield
helps slow it a little, so the baby can have better control. Baby should
be examined carefully for any cardiac or respiratory issues, or even a
subtle posterior tongue tie, which has been responsible for difficulty
with flow control in infants in my practice. I agree with ending the
feeding as soon as the baby shows any signs of difficulty - rapid, harsh
respirations in the pauses between sucking bursts, prolonged respiratory
pauses and short sucking bursts, worried expression, mistimed swallows
(isolated short stridorous sounds made when the vocal folds snap shut
because liquid contacted them). Mom will get good at reading the baby's
signals if she is shown what to look for.
Using positions that allow the baby to let go of the breast whenever he
needs to can be helpful. Mom should keep her hands off the baby's head,
just support his shoulders. This can also increase head extension while
breastfeeding, which decreases airway resistence. Makes it easier to
breathe.
Lynn Wolf and Robin Glass's Feeding and Swallowing Disorders in Infancy
(Therapy Skill Builders) has a lot of great information on these topics.
http://www.psychcorp.com (choose catalog- Therapy Skill Builders; then
search for the title) I have no financial interest in this book, just
recommend it highly.
Catherine Watson Genna, IBCLC NYC
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