OK, there are 2 main things I would be looking for: oral anatomy like tongue-tie or a bubble palate, OR insufficient milk syndrome. Reading your case notes (see below) and maybe *reading between the lines* a little, and I believe there is ample evidence for insufficient milk syndrome. To wit: I would wonder how lactogenesis II presented itself, how much milk she obtained through pumping, how much weight did the baby lose (gaining 660 grams in the first 2 weeks is ALOT, as it is approximately 22 oz, which indicates to me that baby had lost a great deal and this was catch up growth (or the weights were inaccurate, with clothes on perhaps), and then gaining 220 grams the next 2 weeks, this is only about 7 oz in 2 weeks. All the while the baby is being supplemented, so her milk supply never seemed to be enough. I would also want to know about the jaundice, were there risk factors for pathologic jaundice or was this really starvation jaundice. I agree with Cathy Genna about the harder suction trying to get milk out as a possible culprit. I would investigate in detail the history (is the baby premature?) and risk factors for IMS and I would recommend interventions accordingly. It seems she is now on the right track with galactagogues and pumping. I am not a fan of the Lactina, however, for these scenarios. This sounds like a mother who could use a supplementer device at the breast.
<<a one month old ... suffering since the first time she breastfed >> <<baby was "really eating" since she felt such a strong pull, though it was obvious to me that he was getting very little milk. He very quickly got frustrated from lack of flow.>>
<<pain is less when her breasts are fuller. Her milk supply is obviously down. >>
<< Oral anatomy and tongue movement seemed normal. >> << breastfeed in hospital but ...supplemented as well. "he was just very hungry". ...jaundiced and stayed in the hospital for a week under the lights, nursing and bottle-feeding. Mother pumped as well. Mother began almost exclusive breastfeeding at home with the exception of one bottle a night. >> <<gained 660 grams in the first two weeks and 220 grams in the next 2 weeks. He does not come off of the breast alone and does not fall asleep on the breast. >>
Laurie Wheeler, IBCLC, MN, RN
Mississippi, s.e. USA
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