I agree that this does not sound at all like pyloric stenosis. Babies 
with pyloric stenosis are desperately thirsty because they keep vomiting 
almost everything they get, then they stop eating because it is just too 
painful and they are too weak from not enough being absorbed of what 
they are taking in. The belly is generally very tense, and sometimes you 
can feel a grape or olive shaped mass in the baby's lower belly near 
midline. That's the overgrown pyloric sphincter. The condition is 3-5 
times more likely in babies who received any infant formula vs. 
exclusively breastfed babies. Heather McFadden wrote a lovely article in 
Clinical Lactation you can read for more information.

McFadden, H. (2017). Parental Concerns on Gastroesophageal Reflux. 
/Clinical Lactation/, /8/(4), 169-174.

This sounds like classic oversupply. Breast massage immediately before 
feeding (to increase fat content of milk and allow the first MER to 
trigger and relax a little), unilateral feeding, prone feeding (mom flat 
on her back, baby on her belly) can all help reduce the oversupply 
symptoms. Tongue tie should be ruled out, but is very rare in babies 
growing rapidly. I've been tracking this phenomenon with cervical 
auscultation and now ultrasound. Some babies with mild tongue 
restriction can't seem to stop swallowing to breathe and overfeed and 
are miserable, but again, this is very rare. Try the management 
strategies first.

Catherine Watson Genna BS, IBCLC  NYC  www.cwgenna.com

On 1/23/2020 5:43 PM, Nell Blakely wrote:
> Sorry this is long, but please bear with me. I don't post often. I got a
> question from a mom today that I have no frame of reference for answering.
> She is wanting to avoid using Pedialyte for her baby who is going to be
> tested for pyloric stenosis.  She was told (or what she understood) was that
> the baby needed the electrolytes for the imaging. Has anyone ever heard of
> this? I am wondering if they are telling her to fast from breastfeeding in
> case baby has to go for surgery the same day, or because electrolytes can be
> abnormal with pyloric stenosis. In the latter circumstance, I don't see any
> advantage of Pedialyte over breastmilk. Mom is high anxiety. Had two
> late-preterm infants who she only breastfed a short time believing her milk
> supply was inadequate. Her third child was term and breastfed well from
> birth. He was diagnosed with widely metastatic adrenal neuroblastoma at 10
> weeks of age. Miraculously, he is still with us and in kindergarten. She
> became a huge breastfeeding advocate while breastfeeding this child until
> past his third birthday. I worked with her all during that child's
> breastfeeding years. Her latest baby was born a few weeks ago at 36 weeks.
> Good weight, breastfed well, no particular problems except a little
> jaundice, which was not surprising since baby was also Coombs positive. Mom
> was so anxious that some of the same issues she had with the first two
> babies would come back, that she was pumping in addition to breastfeeding
> baby. 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. Several different suggestions with positioning,
> probiotics, etc. have been tried. Mom has also tried Mylicon and Gripe
> Water. Baby has been getting steadily fussier and spitting up more and more.
> Part of me wants to believe that this is either reflux or oversupply. Baby
> has not been evaluated for tongue tie, either. I know it is wise to rule out
> pyloric stenosis. Just want to know what you think. I am talking to the mom
> as an LLL Leader, but have not seen the baby since the day after she was
> born (in the hospital where I am a mother/baby nurse---but wasn't this mom's
> nurse.) Thanks in advance.
>
>   
>
> Nell Blakely, IBCLC
>
>
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