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From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Catherine Watson Genna BS, IBCLC
Sent: Friday, January 24, 2020 8:59 AM
To: [log in to unmask]
Subject: [EXTERNAL] Re: Test for baby for possible pyloric stenosis
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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 https://urldefense.proofpoint.com/v2/url?u=http-3A__www.cwgenna.com&d=DwICaQ&c=cBOA5YEoZuz9KdLvh38YxdrPtfJt83ckXekfBgq5xB0&r=YMPR_zAdF8qkx32i0F0pa2HUsTuK3vXuh_Y9voNUeEI57DM9almiWqjh7wBHOt8G&m=hbajIwvmZMtUhLbubI33jM_kBFZ4c9Tvy4tirij1eZc&s=LL7AjhttdjH9Wj1Wvi3IKMW4X1sZea2ZsyAA6wbcDk8&e=
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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