Jaye,  
We all do the best we can with the information we have at the time.   Yes, 
the first rule is "feed the baby".  She is doing that even if baby  isn't taking 
the "required" amount.
What about the approach of "re-training" for oral aversion?  Maybe  some oral 
games with toys or fingers?  If problem is with baby's mouth  refusing food 
then mom might not feel criticized.  She becomes the one who  can fix the 
problem.  If baby weren't eating at all or was listless etc.  then baby would be 
FTT and hospitalized.  Not that we want that to happen  but it doesn't sound 
like this kid is going to let that happen either,  regardless of force feedings.  
Force feedings are making the situation  worse, obviously so the trick is to 
get mom to see an  alternative.



My nephew and his parents have had feeding issues for years (he is now  12) 
and he refuses to eat more than about 12 items (which include french fries,  
chicken nuggets etc).  Things got so bad that he when he was sick at age  nine 
with normal flu he lost so much weight he was hospitalized for several  days.  
This has nothing to do with food and everything to do with  control.  When my 
husband and I took him with us for dinner (with our kids,  younger than he is) 
and told him he could not order his normal dinner and had to  try a bite of 
everything everyone else ordered he said he was going to call his  dad.  We 
told him we would call his dad for him.  He didn't really  want to do that after 
all!  AND he ate three or four new things he liked  (ribs and shrimp among 
them).  I was worried his mom would be upset but she  gave me the silent "thank 
you" over his head as he related his food adventures  to her.  This is NOT the 
situation your mom wants to be in.   By making this an "oral aversion" / 
behavior issue SHE can fix so that the long  term is better you empower mother to 
change the cycle.
 
I would phrase this to mom as a behavior issue.  Baby is learning  that he 
has control over mom, it's not about food.  Yes, baby has to  eat.  Yes, it's 
nerve wracking when baby doesn't eat.  But the long  term focus is to make 
breastfeeding (and subsequently solids) enjoyable for BOTH  mom and baby.  We don't 
want baby to learn (or keep learning) that feeding  is a struggle and power 
play.  Sometimes changing the approach from  "feeding issue" to "development 
issue" helps mothers see the long term effects  of their actions rather than 
focus on the short term results they are frantic to  achieve.  Babies who are 
starving are listless etc.  She KNOWS her  baby isn't starving.  Babies are also 
not suicidal, as evidenced by the  baby eating when he is tired.  Goal is to 
increase baby's pleasure with  eating.  I would suggest mom using SNS to finger 
feed baby while baby is in  a light sleep state.  This works very well 
because mom is able to stim.  suck reflex with finger and get baby to eat without a 
struggle.  Baby can  be fed this way without moving or waking fully.  If she 
does this while  baby naps and at night then she can relax knowing he is 
getting calories.   If he wants to nurse during the day then that is great.  I would 
also  encourage a co-bathing session each day (or as close to that as 
possible).   This is to relax BOTH mother and baby and bond.  NOT to feed. (Of course 
if  feeding happens, which is usually does that is great.  Many times I  tell 
moms, bathe with baby to help bond with baby instead of worry.  I  don't 
mention feeding  so there is no expectation. At least in the end  you are both 
clean!)
We all do the best we can with the information we have at the time.   Yes, 
the first rule is "feed the baby".  She is doing that even if baby  isn't taking 
the "required" amount.
What about the approach of "re-training" for oral aversion?  Maybe  some oral 
games with toys or fingers?  If problem is with baby's mouth  refusing food 
then mom might not feel criticized.  She becomes the one who  can fix the 
problem.

Not the most coherent post ever, suffering from jet lag...just returned  from 
Asia! But I hope there are some things that help you.
Best of luck!
Warmly,
 
Christie Pillado
Motherhood Intact
El Paso, Texas


Date:    Fri, 3 Nov 2006 10:53:38 -0800
From:   "Jaye Simpson, IBCLC" <[log in to unmask]>
Subject:  Re: milk supply gone

Hi All,



To answer a few  questions:  Baby is NOT getting solids and is not ready for
them - he  pushes anything that goes into his mouth immediately out.  I think
this  may also be related to the force feeding - not sure exactly when that
started  - sounds like it was last week but moms answers don't always 'jive'.
I am  trying to piece together a puzzle with pieces that aren't always
fitting  together correctly.



Baby nurses all night long - last chart  showed feeds about every 1.5 hours.
Whether or not those were forced by mom  or asked for by baby I don't know.
According to mom she offers the breast  many more times per day than 8-10.
Again, not sure if she is pushing baby to  eat or if he is asking.  He
interpretation of his cues is interesting  actually.  She takes his desire to
chew on clothing as a hunger cue -  could be - who am I to disagree?  He is
teething so is chewing on his  hands frequently and loves to suck on his
fingers!  Heck if I thought we  could tape an SNS onto his finger he could
darn near feed himself!   :-)  Mom is desperate for this baby to eat more and
to take a  bottle.  



It will be very difficult to encourage this mom to  stop force feeding this
baby.  I tried last night by stating several  times throughout the consult
that ALL feeds MUST be happy and relaxed.   Her response continued to be an
insistence to forcefully dropper feed to make  sure he got enough milk in.  I
am not sure how to stop the force feeding  without coming off in a manner
that suggests to her that she is doing  something really wrong thereby
alienating her completely.  She is so  thoroughly convinced her supply is
failing that I doubt I can convince her to  simply watch the baby and feed
when he asks.I need her to stay in contact,  trust me and talk to me.any
suggestions on how to word this would be  appreciated.  



Re: The scale - she is not obsessing on  it.  My reasons for this were to
determine exactly what was going on  with this supply and to show her that
baby IS getting milk.  She only  has it for a week.  Provided she is charting
and weighing correctly  (which we went over thoroughly) then it will give me
and her some good  information.  I don't think this will cause her any grief
- she was  pleased to see that her breasts are not completely empty as she
thought they  were.



Re: Fenugreek.  She is taking 4 tsp of the seeds  soaked in water (as per her
culture) per day.  She smells like  maple!  Is this an appropriate dosage??
I am much more familiar with the  capsules or liquid tinctures and told her
so.  Input on that would be  helpful as well.



I think that is it - to those who have posted  publicly and privately THANK
YOU!  You are really helping me piece this  all together and giving me other
things to look  for.



Warmly,

Jaye





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