HI Karen, Marsha and All,
Thank you for the replies. It seems to be the consensus that Mom
stop the feedings as soon as the choking and difficulty breathing begins. We
have discussed this and she is planning to use is the approach today.
Hopefully short and more frequent feedings will lessen the episodes. Mom is
most worried about him getting enough if she doesn't continue feedings for
longer. I am trying to reassure her. We'll do weight checks frequently. As
of right now she is still doing cabbage to try to reduce supply/ hyperactive
let-down. Also using only one breast per 4 hours of feeds then switching to
the other.
The thing is he acts like he is still hungry and wants to nurse, but
he just can't because do it correctly. There is no defined pattern to it.
Sometimes he feeds well and other times he just doesn't. It is very
perplexing. Mom has not forced any feeding pattern on him, the timing is his
timing. He actually began long er stretches of sleep at night at around
three weeks, mom initially woke him after 5 hours, but now lets him go to 8
hours.
The prone positions and nipple shield she tried for all feedings
yesterday did not help. He still had the same feeding problems. Mom reported
that prone positions were uncomfortable for both of them and it was much
harder for her to see him feeding, especially lying on her back, so she
couldn't interven as easily when he was in distress. Nipple shield didn't
help either. She did frequently empty milk out of it to help reduce his flow
when he would go off and on. During feedings Mom is soaked because whether
he is latched or not milk continually runs from her nipple and is caught in
a towel or breastpad.
The first time mom reported this specific behavior to me was at 4
weeks old, however every contact prior to that she described fussiness. On
hearing her descriptions of the behaviors at the time I thought it was
growth spurt, thrush (mom got a very strange rash on her breasts for a
while) a cold or allergy. This was before I saw him feed.
I have had laryngomalacia on my mind with this case for a while. It
is something that seems to present more severely as baby gets to this age
also, right? One source I have says diagnosis must be with direct visual
scoping. I am thinking that the swallow test cannot show this problem. Is
that right? Is that something you all think I should pursue.
I am thinking we should have an OT consult on this. Do you think
it's the next best step? I haven't pursued getting lab work on mom regarding
hyperprolactinemia as yet. Though I think she will want ot investigate that
for her own health at some point. I am trying to work this out with
breastfeeding management first.
I am glad to have your respected opinions. Thank you.
Judy Gutowski, BA, IBCLC, RLC
-----Original Message-----
From: Karen Gromada [mailto:[log in to unmask]]
Sent: Wednesday, August 10, 2005 2:02 PM
Subject: Re: hyperprolactinemia and choking baby -long
> Baby problem - I am working with a mother and her 12 week old son born
at
> 36 weeks gestation, 7#10. Choking and difficulty breathing occurs
> during feedings, both breast and bottle. He does alright for the first
> 3-5 minutes takes in 2-3 oz in 5 min or less, but then starts to
> struggle. He comes off and on the breast and feeding will then take 45
> min to an hour to get another 1-2oz in him. His latch is shallow as I
> would expect with the fast flow - guarding. He normally takes 7 feeds
> in 24 h and sleeps 8 hour straight at night.
What happens if everyone simply respects baby's cues -- both to BF and to
stop in 5 min or less? If doing alright during that time and taking in 2-3
oz in that time, why "make" him stay at breast when he seems to be saying
stop? (All but the first of my 5 babies, including my twins, generally BF
for 5 min or less within 2 weeks postpartum.) Would he simply cue to BF for
more often? Seven BF in 24 hours is not the norm nor is going 8 hours at
night at his age. If he wasn't having issues, I'd say "if it ain't broke..."
but forcing him to continue does not seem to be working. Is there some
reason this baby can't be trusted to know what he wants/needs as per other
fully BF babies? (Even age-adjusted to 8 weeks, he should be able -- and
seems to be trying his darndest -- to be trusted to cue for feedings.)
Unless there's some compelling medical reason that I'm missing, I'd suggest
the mom back off and let the baby set the pace. I'd highly recommend some
mother-baby kangarooing between feeds so baby can just enjoy the ambience of
Mom's restaurant without any pressure to clean his plate.
I'm not sure I understand why hyperprolactinemia is suspected; her volumes
aren't that unusual -- especially if the breast is only being "emptied" 7x
per 24 hours. Could she be stimulating an artificial overproduction by too
much pumping on top of baby's BF?
Karen
***********************************************
To temporarily stop your subscription: set lactnet nomail To start it again:
set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All
commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer
for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
