Hi Mandy,

I have a couple of thoughts about your case. First and foremost, the mother
needs emotional support, as you have given her, and help to see that this
could be a long-term (might take a week or so) rather than a short term (a
day or so) situation. This is not unusual with an early term infant. I
often see a baby who is feeding well, begin to have trouble when the feel
and flow of the breast change at around when the milk comes in. This may
have coincided somewhat with when the baby required phototherapy, and if
there was some mother-baby separation during the treatment, this may have
thrown their synchronization off.

My other thought is that the baby has trouble with the flow of the breast,
perhaps it is too fast and baby is protesting that. Perhaps baby can
control the bottle flow easier. Positioning at the breast is important,
especially if baby feels at all uncomfortable related to her airway (too
flexed?) or her nose getting blocked. I very very often see that babies and
breasts are not well supported and the baby especially looking like they
are dangling and falling. During bottlefeeding, the baby may be much better
supported and can calm down and organize. I would pay careful attention to
how well the baby's whole body is being supported by the mother's body and
arm(s).

Of course, I highly believe in skin to skin kangaroo care, and the laid
back position can really help for that positioning and stability I'm
talking about, and controlling the flow if the fast flow is a problem. I've
had success with the 'bait and switch' tactic mentioned by another
lactnetter, where baby is in a breastfeeding position, starts with the
bottle of ebm to ease her hunger and to get herself coordinated, and is
switched to breast after about 1/2 oz. I hope you find some of this
helpful.

Laurie Wheeler RN MN IBCLC
MISSISSIPPI USA

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