PTP. Forgive me for the long post. Trying to cram 3 weeks of information into one post! I have a family who started off nursing beautifully on their own, infant to breast within 10 minutes after an induced labor due to high blood pressure at 39weeks 3 days. The hospital LC came in and told the mother that her nipples would be to flat to nurse (even though she had already latched and nursed successfully 3 times at that point) and insisted she use a nipple shield. The nipple shield seemed to cause more problems and then from there the infant started to have trouble latching. Mom is very very nervous and takes any set back very hard. After the nipple shield incident mom became extremely stressed out and worried that she wouldn't be able to nurse, that she wouldn't be able to make enough milk and a very long list of possible issues that the LC mentioned to her. To compound this the infant lost 8% body weight and the pediatrician pushed formula telling the parents they were going to cause brain damage if they did not give the infant formula. This caused even more nipple confusion. The mother also had delayed Lactogenesis II and did not produce mature milk until 8 days PP. 

By the time the dyad reached me ( on day 7 )I was able to combat the nipple confusion, and the infant latched perfectly again. Once mother had mature milk the baby stopped losing weight and has steadily gained since that point at about 1/3 oz. a day with minimal formula supplementation. The family is very determined to use only breastmilk. However, the infant is being supplemented with 1/2 oz to 2 ounces of EBM after each feeding which she is becoming more and more resistant too. By resistant I mean that the baby refuses the bottle when presented to her. 

Here is why I think the infant might have some sort of GI issues. The infant also has a very high suck need sucking nearly constantly. I believe the high suck need is due to the fact that the infant is not passing stools. We have done pre and post feeding weights and milk transfer is good and more than appropriate. She is producing 10+ wet diapers a day at nearly 3 weeks old but has only passed a bowel movement 4 times in her life (other than day 1 and 2 where she passed all her meconium). The pediatrician does not seem concerned about this at all and told the parents it is normal for a breastfed baby to only poop once a week. I, however, am very concerned. Last night after nursing for 40 minutes the infant took a 2 oz bottle and drank all of it. The father was concerned because this is well over her stomach capacity. She did not spit any extra out but the parents both noted that she made a gurgling sound as it the milk was stuck in her esophagus. She has never spit up. My concern is that the child has a motility issue, possibly even an absorption issue. That she should have either spit up or passed a bowel movement when being overfed but has not. I am even more concerned that even with daily rectal stimulation, massages, and everything else one can think of to stimulate a bm she still has not. The pediatrician is singularly concerned about weight and nothing else so I really want to make sure I have all my ducks in a row before I say that I believe anything else should be looked at or have the patient referred to a pediatric GI. Thoughts? 

Alicia C. Simpson MS, RD, IBCLC, LD
http://peapodnutrition.org

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