Dawn,

You have done wonderful work with this mother and baby, and the mother has 
done so much to progress.
I wonder if this baby is refluxing? - Arching and in apparent pain are two 
things you mentioned repeatedly, and some of these babies associate feeding 
with acid reflux and don't want to feed, or try to get away from the breast, 
while feeding. When at the breast, lying down, with stomach and mouth at 
similar levels, there is no assistance from gravity to keep the acid down in 
babies who can't clear any acid that comes up. Plus more acid is made to 
respond to the feed. (Adults, as well as kids.)  If it stays in the stomach 
it does its job, but if it comes up and a particular baby can't clear the 
acid, you have a scenario similar to what you describe.

Posture changes with head and mouth higher than stomach, getting medical 
treatment for possible gastro-oesophageal reflux (GOR), should help, though 
lots of patience and skill will be needed in re-interesting the baby in the 
breast. You say she is behaving similarly on a bottle she is having.  A 
sitting-up position with back support may help; also pacing the bottle feed. 
If it is reflux, the baby is probably distressed at nappy (diaper) changes 
and would benefit from postural changes while being changed, such as raising 
the head and shoulders. Does the baby get upset a short while after being 
laid down after a feed? If so, being held in a sling on or Mum's shoulder or 
across her body for 20-30 minutes will let any acid that has come up drain 
back down. There are good sources out there on managing feeding with GOR.

Virginia
in Brisbane, QLD, Australia

----- Original Message ----- 
From: "Dawn Kersula" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, September 25, 2013 12:27 AM
Subject: Fussy at Breast - Help Please! (Long)


> suspect this is the most complicated case I've seen in 30 years...
>
> Called by mom of 5 week old whose baby was dx'd with TT over the phone (no
> comment). Mom was using a nipple shield but felt baby wasn't transferring
> well. When I watched baby feed, I realized the poor latch was not all - 
> mom
> had Type II hypoplastic breasts http://www.sonic.net/~mollyf/igt/  Baby 
> had
> slid to the 3rd percentile (birth weight was 25th percentile) even with
> supplementation (via bottle, medela regular-old nipple).
>
> Baby's latch was all over the place, with or without the shield. A digital
> assessment showed baby could trough, lateralize, lift the tongue to the
> roof of the month, and bring the tongue over the lips. There was good
> strength to the suck, and a normal waving of the tongue with the suck. 
> Once
> mom started stabilizing the breast, baby could stay on, and over the weeks
> the feeds continued to improve.
>
> Slowly but surely mom's supply has increased (fenugreek, blessed thistle,
> then goat's rue and then domperidone) to the point where she is now able 
> to
> feed/pump enough that the baby has all mom's own milk. (And has had three
> plugged ducts.) Down to 1-3 bottles (~1.25oz each) per day. Baby's
> preference is to feed ~q 2 hrs during the day and sleep one long stretch 
> at
> night (~7 hrs) which she has been doing pretty regularly for the past 4-6
> weeks.
>
> Two weeks ago (baby 11 weeks) the mom described the baby as "fussing 
> around
> at the breast" but of course everything looked wonderful when I saw them.
> Maybe a bit of what I interpreted as 3 month old behaviors - too nosey to
> settle down.  And the baby was getting closer to the weight we wanted.
>
> Yesterday mom came - quite understandably in-between melt-downs - and I 
> got
> to see what she was talking about. Baby was all over the place - latched
> on, arched her back, squirmed, came off. Kinda latched on the end of the
> breast, pulled off to look around - of course with the nipple still in her
> mouth. Mom describes this as happening whether the room is dark, light,
> quiet, noisy. (I wondered about sensory overload.)  She transferred 30 cc
> of milk while doing this - more than she used to get when we did "four
> sides" at a feed. She then settled down and had a bottle of mom's own --
> although she is  kind of messing around on the bottle nipple too. And her
> suck still takes a while to organize if you give her a finger to suck.
>
> MOM ADDS:
> she is focused on feeding, wants more, but it seems like she is
> experiencing some weird pain or reflex that won't allow her to get it.
> pulls off even when milk is flowing.
> sometimes just barely touches her lips to the breast and pulls away.
> latch is either too loose or too shallow, or she latches deeply but pulls
> the nipple away from my body,pulling it taught and out of the back of her
> throat.
> baby sometimes tries to nurse with nipple in side of her mouth.
> when she arches or pulls her head away, i feel like she is frantic and
> experiencing discomfort (pain or trouble breathing)
> she sometimes passes gas when she arches
> if i express milk while she is gumming the nipple, she sometimes pulls 
> off,
> sometimes suck-swallows.
> often is whimpering throughout the entire process, squeeling if i try to
> keep her from pulling off,  and cries when i take her off for any reason.
> we often do better when she is sleepy
> we are having some success today while she is sleepy and i rock her or
> carry her around
>
> Overnight mom says the baby nursed calmly for a short time when she nursed
> her standing up, walking around!
>
>             ***********************************************
>
> Archives: http://community.lsoft.com/archives/LACTNET.html
> To reach list owners: [log in to unmask]
> Mail all list management commands to: [log in to unmask]
> COMMANDS:
> 1. To temporarily stop your subscription write in the body of an email: 
> set lactnet nomail
> 2. To start it again: set lactnet mail
> 3. To unsubscribe: unsubscribe lactnet
> 4. To get a comprehensive list of rules and directions: get lactnet 
> welcome 

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome