>
>I've been dying to write more messages but I always run out of time before
>I finish reading all the new ones!  Lactnet is wonderful!
>
>I have had many , many clients with babies refusing the breast, my last
>just this morning.  I agree with those of you who felt that the baby is
>reacting to a past negative experience in most cases.
>
>If the mother is willing to keep trying and is maintaining a good
>milk supply these babies usually end up breastfeeding.  Because I am in
>private practice and my clients are paying for my services I feel that
>they need to know that their baby can indeed breastfeed before the end of
>that first visit, so that's what I try to achieve.  Once I get one
>successful latch with sustained suckling, then we work on teaching the
>mother how to achieve the same results.
>
>I constantly talk to the babies, reassuring them that it's okay.  Babies
>will stop crying to listen to you.  I hold them in good breastfeeding
>position until they start to root to comfort themselves and then bring
>them on.  It takes a very calm, reassuring manner and patience but it
>inevitably works.  If you are calm, then the baby usually becomes calm too.
>
>However, I have had two very challenging cases so far this year and I
>would like to share them with you.  I felt hesitant about putting them on
>the Net even with no names so had to check with the Moms first but they're
>willing if it helps others.
>
>1st: Baby girl born 2750 gm., fullterm - induced because of ruptured
>membranes with meconium staining.  Brought to breast within 1st hour, then
>bottlefed because of hypoglycemia. Refused breast vociferously from then
>on. Mother started pumping 24 - 36 hours post-partum.
>
>I saw her @ 5 days.  Latched only once and then only after Starter SNS was
>added at breast.  This baby screamed and screamed and needed much calming
>for each try.  Mother was instructed to try baby at breast with Starter
>SNS for a max. of 15 minutes at each feed. If unsuccessful in that time
>she was to bottle feed pumped milk using Medela orthodontic nipple as
>demonstrated, ensuring baby took whole nipple in mouth, had flanged lips
>and was using wide, regular jaw motion.
>
>By the next day, baby was refusing breast and orthodontic nipple, so
>Mother was advised to finger feed at breast with SNS Starter until baby
>calmed down.  Telephone contact was maintained over next 8 days and mother
>did visit a Breastfeeding Drop-In and see a PHN/IBCLC and had a PHN visit
>her at home at least once.  However, no further progress was made.
>
>In addition, the mother had very sore nipples - cracked and open, and baby
>had yeast orally and peri-anally.  Treatment for mother and baby was
>recommended.  Mother saw MD and started Nystatin for all areas.  Baby
>continued to be very irritable about feedings and very "screamy" which Mom
>attributed to sore bottom and decided to continue with just finger feeding
>until yeast was better.
>
>However, she did take me up on my offer to exchange her Egnell full-size
>pump for a 24 hour free trial of a Lactina with double kit. (This was the
>5th time I'd offered this to Moms and all have chosen to keep the Lactina.)
> Her sister picked up the pump and said mother had to bite on a wet
>facecloth when she turned the Egnell on on minimum to keep from crying out
>in pain!
>
>At one month and 1 day, I actually saw this mother and her baby again in
>person when they came for an office visit.  Thrush was better, breasts had
>healed and mom felt she was finally ready for another go at breast.  I had
>not had much contact in previous 2 weeks.  Baby weighed 3320 gm and was
>51.5 cm. long, 25th%ile wgt. for length.  Amazingly, this mother had
>continued to use and boil for 20 minutes daily her "disposable" SNS
>Starter.
>
>I told her I really had not intended her to continue using this system for
>a whole month when I'd first seen her and felt we should move to a
>Lact-Aid Nursing Trainer, explaining the difference between the
>gravity-feed SNS and the infant-controlled Lact-Aid.  With the Lact-Aid
>and a few good conversations with baby, she latched very well and fed at
>breast, taking her usual feed of 60 ml. from Lact-Aid bag.  Mother was
>delighted that baby actually latched many times with only a little resistance.
>She continued to feed at breast with Lact-Aid from then on.
>
>However, I had concerns about this baby on 2nd viewing.  The matatarsal
>bones looked disproportionately short, as did the humerus bones. Baby 's
>colour was mottled even when skin to skin with mother, and baby was,
>still, I felt, overly irritable with no social smile at 1 month(unusual for
>my clients).  I told mom I would phone family physician re resuming Rx for
>yeast as her nipples were still pink and burning and baby still had
>peri-anal rash. I also told her that babies don't refuse the breast like
>this for no reason and that this baby was trying to tell us something.
>
> While talking to MD about yeast, I also told him that I didn't feel
>"good" about this baby. The PHN/IBCLC had said she felt there
>was something "different" about this baby. I have a good working
>relationship with this doctor and he said he would call Mom and have her
>bring baby in.  That was just before the 4-day Easter holiday.
>
>He saw the baby the next week.  Told Mom there was a heart murmur, told me
>the baby's heart sounded like a factory, and referred baby for an
>assessment at Children's Hosp. scheduled for next week.  Baby was seen,
>immediately admitted to ICU, and scheduled for heart surgery the next day.
>
>In the 12 days since I had seen the baby and she'd started on the Lact-Aid
>she'd gained another 180 gm and was 3500 when she went into the OR. Mom
>slept in the crib with the baby that night and nursed baby pre-op - and
>only one nurse grumbled!
>
>This baby had: coarctation of aorta down to 1 mm which was corrected using
>artery from L. arm.  Still to be corrected in next 3 -9 months with open
>heart surgery are atrial and ventricular septal defects and poss. also
>mitral valve.  Mother says baby has 4 holes in heart and it was only
>because all the blood was mixing that she was ok!
>
>Initially, all involved were pretty upset that this baby was not picked up
>but I think she had a guardian angel who kept her from getting diagnosed
>until her parents had fully bonded, established (sort of) breastfeeding
>and viewed their baby as normal with a "Irish/Turkish" stubborn
>personality irritated by a sore bottom. Dr.s at hospital felt there were
>many other abnormalities ie eyes funny, urethra high, club feet, dimple at
>lumbar spine, but geneticist ruled everything out so far and chromosomal
>studies are not back yet.  She does lots of social smiling and cooing now!
>
>We're still not sure what the future holds for this little girl but she's
>certainly taught a few of us around here to look beyond the "refusal".
>
>Sorry I wrote a book.  Couldn't stop once I got started.
>
>

--
******Joan M. Fisher, RN, BN, MEd, IBCLC******
***********Ottawa, Ontario, Canada************
          [log in to unmask]