How does he do with the bottle? Sucking on finger?
Melinda Harris-Moulton, ARNP IBCLC
Washington state
Sent from my iPad
> On Mar 14, 2015, at 7:18 PM, Debbie Dixon <[log in to unmask]> wrote:
>
> Hi all
> It is interesting this discussion has just started, as only this week I have had a client with a 6 week old baby who has unresolved jaundice. I wanted to post here to get some responses from other practitioners here. She is understandably very concerned & thinks something is wrong with him.
> PTPMy first communication with her was when baby was 10 days old & she rang to enquire re my services as she "couldn't get the attachment right" and felt very clumsy handling him. He is her first baby. She booked an appointment with me and then cancelled it the next day, saying she had decided to wait a few weeks "to take more time to get more comfortable with what she is doing". I checked in with her once over those few weeks and she said he was very unsettled and wanted to be close to her for the last few days. She thought feeds had improved a lot though and that she didn't want an appointment yet. I said to call anytime when she wanted to go ahead.
> She contacted me about 10 days after this and wanted an appointment, as baby was extremely sleepy and wouldn't stay awake long enough to feed properly. She had tried all the usual ways to wake him up but they don't last long.
> Baby was born by planned C-Section at 38+4 weeks due to a breech presentation. Mother and baby were both well at birth. Pregnancy was good (no medical problems). She had immediate STS contact & early breastfeeds which continued 3-4/24 over 1st week. Mum says he has always been sleepy and was jaundiced from birth (but there was no concern about this from doctors or midwives in the hospital or on early post-natal midwife visits). Weight gains have been good - no concern (and has seen GP and midwife several times since birth).
> Cues normally to feed, looks interested initially, searches for breast, will attach, but then doesn't maintain the interest in the feed. I do not notice the normal sucking pattern & don't think the attachment is good (but have been working with her on ways to optimise that). I found him fairly lethargic (and noticeably jaundiced, but appears mostly on head) and only attaches for a few minutes and then just nibbles or goes to sleep. Mum is needing to wake him for feeds and has started expressing with an electric pump now to maintain supply, and is feeding him top -ups in bottle. She thinks he's getting "nothing" from the breast directly. She thinks his nappies have not been as heavy as they were, but they are not concentrated, and the dirty nappies are loose yellow & are at every feed.
> She is seeing her child health nurse this week coming for a 6 week baby check and vaccinations and the doctor for her post-natal check. The doctor she saw this week (when baby was lethargic & not feeding well) said all was OK but they wanted to check bilirubin levels this week.
> I have suggested she offer both breasts, waking baby every 3 hours if not waking, then to feed previously expressed milk by a bottle (as that was what she had been doing, and she is very anxious & stressed, and I don't think she can handle any other feeding methods, and is probably best left with the bottle just for now). Then she would express (both breasts) with electric pump. I said to do this intensively over the weekend and we can reassess this early in the week.
> Does this sound like an extended jaundice (breast milk jaundice or non-breatsfeeding jaundice, or both)?
> Does anyone use any methods to get baby awake enough to feed at breast, or is this not likely to happen until the bilirubin levels go down (as I feel sure this is at the bottom of the problem). Would an at-breast supplementer be useful, or pointless with a baby not staying awake to actively suck? Or could you deliver the milk faster to stimulate him to wake up and swallow? Of course, I have encouraged her to keep in close touch with the GP and child health nurse (and to have the bilirubin testing done).
> Thank you for any suggestions.
> Debbie Dixon IBCLCDUBBOAUSTRALIA
>
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