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Date: | Wed, 4 Apr 2007 11:24:21 EDT |
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This is all very interesting on both the descriptions of these babies and
the theories to why they act this way.
I truly believe if a newborn is crying often and having difficulties being
comforted, they are trying to tell us about their pain. What I hear from
staff is that these babies are "starving" and the poor mothers feel their babies
are rejecting them.
Many times these babies are content with being held, rocked and not fed.
I had a case yesterday where the baby was the result of a long labor that
arrested so the mother ended up with a c-section. The first time I am seeing
her is on day 3. The baby is down 10% from birth weight and the pediatrician
has already told the mom that the baby has to be supplemented after each
breastfeeding.
Mom describes that all breastfeedings have been difficult. The baby cries
at the breast and it takes anywhere from 15 to 30 minutes to get the baby to
latch. The night before I saw her she described that her baby refused to l
atch on several attempts and finally latched by 6 AM.
When I arrived the baby was sleeping in grandfather's arms. Placed the baby
skin to skin on mom's chest and reviewed the states of babies. When her
baby moved into light sleep, I had mom gently stimulate her baby to quiet alert.
Then mom moved her baby to the clutch hold. Once the baby left mom's chest
and moved into this nursing position he started crying. Mom hand expressed
her breast milk but baby not interested. His crying escalated, so I had mom
try to offer her finger. Baby refused to suck on mom's finger. The only way
this baby would stop crying was when I picked him up and walked him. Than I
had mom try a side lie position but baby only arched and screamed. By this
time mom is in tears asking for formula. She was not interested in
expressing her own breast to give her milk. I did not feel comfortable with having
this mom bottle feed this baby and wanted to observe how this baby would
respond so I started the bottle feeding. The baby continued to cry with any
attempts to feed him. Touching of the bottle nipple near his lips or the smell did
not calm him. He would not suck on a pacifier either. Finally I tipped the
bottle down so baby only had the nipple in his mouth but no fluid in the
nipple while I waited for him. He eventually started sucking, than I gently
allowed some formula into the nipple. I used paced bottle feeding and he
controlled the flow at his own pace. What was interesting is that he held his
hands in tight fists over his eyes during the whole feeding. As he became
calmer, I gave him to mom to finish the feeding. I encouraged her to keep the
doors open to breastfeeding and/or expressing her milk.
I wonder what made this baby so hypertonic and fussy? I could theorize his
birth or even too much effort by others to get him to nurse. Than there is
the growing tension that mom was demonstrating.
I have no answers just observations. I do believe this baby is looking at
long term feeding issues if his problems do not resolve soon and the
appearance that a bottle can be put into his mouth is not necessarily a good or safe
solution.
Ann Perry, RN, IBCLC
Boston, MA
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