Dear Nell,

My first thought in reading you post was wow, this mom has been through a lot of stress with her first three children.  It sounds like she assumes responsibility for anything that isn't going well with regards to the health of her children and with breastfeeding.  I am so glad she has a knowledgeable person to talk to who understands breastfeeding from the mom perspective and who can give her support and encouragement. 

By the time I read about the fourth baby, I wonder if all the stress and anxiety that has built up from the first three experiences has colored how approach with this baby. I can't offer anything regarding the use of Pedialyte from a medical standpoint related to imaging.  If your thoughts about possible surgery being scheduled after testing, we know that breastmilk is no longer taboo  and baby can fed fed within 2 hours of surgery (Lawrence and Lawrence).  If the electrolytes are necessary for the imaging (and I would suggest she get that clarified prior to the testing), the Pedialyte can be given via SNS so as not to interrupt breastfeeding.

My thoughts are that perhaps this is severe oversupply brought on by mother's anxieties.  You share that she did not persist in breastfeeding with her first two out of concern that her milk was not sufficient.  She successfully breastfed her third despite his health issues, and I am sure there was lots of stress in that time.  Her milk was seen as very valuable for the health of that child. With his other testing and procedures, she may not have been focused so much on supply as she was on keeping him breastfeeding, which he did for three plus years.

Now she has a baby born without issues but a little early.  You share that she was looking at her experiences with her first two and was determined and anxious to make this go well.  There were no other issues to distract her from that goal to feed this baby well.

From all that you describe - "Baby is up three pounds from birth weight (6 lbs. 2 oz. to over 9-1/2 lbs.) in just a few weeks. Baby has been very fussy, gassy, and had symptoms of silent reflux." - seem to indicate extreme oversupply. You have given her several really good suggestions, such as alternate positioning, and she has tried different approaches commonly suggested for reflux without relief for her or baby.  My thoughts are that those may not work if she is also pumping after feedings out of her anxiety that she have a good milk supply.  Has block feeding been attempted?  It is basically a procedure to help decrease an oversupply, often accompanied by an over-active milk release. This is a good article to explain the process if the mother has not attempted it -  https://internationalbreastfeedingjournal.biomedcentral.com/track/pdf/10.1186/1746-4358-2-11 

I hope someone else can answer the question about Pedialyte.  Please let us know how this resolves.  This mom is fortunate to have your support.

Cindy Garrison, BS IBCLC

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