Hi all
I am relatively new in private LC practice and saw a mother today who has a 4 month old baby who is suddenly refusing the breast. I would be grateful of any ideas to suggest as I hope I'm not missing something. She has given me permission to post. 
Uneventful post-natal period up until about 2 weeks ago. Was breastfeeding very well from birth for 16 weeks.  First child (now 2) fed for 8 days due to "attachment problems".  Suffered post-natal depression after birth of first baby (now resolved after counselling & support groups); she says she feels fine now. 
Present baby now stopped breastfeeding from both breasts when he was ill with a high fever for 2 days, followed by appearance of a rash. Was hospitalised and found to be dehydrated and received IV fluids. Mother started expressing with hand pump while staying with baby in hospital and feeding EBM in a bottle. Baby then discharged and doctor says fever and rash caused by "a virus". Over this time of illness, nappy count had reduced. Now having adequate urine output again and apparently rehydrated. However, bowel movements pattern has changed; not loose & yellow anymore, but between yellow & brown, sometimes green and "smell disgusting". Baby gets some wind and draws legs up as if in discomfort. GP has ordered stool samples, awaiting results. Also waiting on results from stool samples taken whilst in hospital. After a feed (of expressed breastmilk), is relatively content. Weight gains and other measurements good.  (First child diagnosed with severe reflux & cows milk protein intolerance and was started on Neocate formula from early weeks).
Today, when I was there, mother attempted to attach to feed, but baby almost immediately came off and cried and refused to feed, becoming very agitated until soothed with holding upright or giving more EBM in the bottle.  Mother then fed EBM in a bottle, which baby takes well. Tried offering breast again a number of times with no success. Suggested expressing drops of milk to rub on baby's lips first before attaching and also giving EBM in a cup but these did not work either. Mum has flat nipples and has also tried using a nipple shield (obtained earlier for now comfortable previously sore nipples), but didn't seem to improve things. After feed of EBM, baby then settled to sleep in cot. Normally wakes spontaneously about every 4 hours to feed. 
Mum wants to breastfeed but has had enough of the expressing and struggling to breastfeed. She would like to continue for the first year or so but not at the expense of her health and the rest of her family, as she doesn't want to become depressed again. She says she would be happy to stop now as she has done well for 4 months to this point. She recognises the importance of breastmilk but says she probably wouldn't want to express to feed him the milk and will probably buy some formula to have on hand to possibly start soon if the refusal continues for more than a few more days.  She is also considering starting rice cereal  soon as she has heard the new recommendations are to reduce the age from 6 months to 4 months to lessen allergies.  (I have heard about this from a GP too. What does anyone know about this)?   In spite of these comments, she had nevertheless contacted me for help to see what was happening and what could be done. She is being followed up by a GP whom she trusts and will be seeing the hospital paediatrician to follow up after the virus and dehydration. She sees a chiropractor for her own neck and took her first child to him previously, and intends to see the chiropractor again soon. 
Mum is surprised by the sudden refusal to feed. I explained it could be a number of factors, then triggered by the viral illness (with something maybe lingering, and now baby knows he can get his milk by the bottle easily, is frustrated with having to work at the breast, also that her supply has likely dropped somewhat). She is wondering if there is an intolerance but is waiting for results. Her own diet does not contain a  lot of dairy. Meanwhile, she is finding it all heavy going with the struggling to feed and the effort with expressing. 
Anyone with any ideas or suggestion I can offer her? 
I suggested the usual reasons for refusal but wondering if I  am missing something, as I feel something else must be going on, that, once resolved, will allow him to breastfeed again if she can endure this stage while she is waiting for results.
Many thanks,Debbie Dixon IBCLCDubbo NSW Australia   
 		 	   		  



    
     

    
    






   		 	   		  


    
     

    
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