This weekend I had a frustrating case.
A recently discharged term baby of a 20 y/o mom who had gestation DM needing
insulin. Baby latched very poorly in hospital if at all. Mom's supply is
good. She even pumped an once 6 hours post partum. Went home with iffy
latching and copious pumping.
Baby seen the next day and one of my nurses got him to latch on one side.
The next day I saw him and parents said he had not latched in 24 hours to
which I asked how did he gain 2 ounces (60 grams)? Mom is hand pumping and
syringe feeding. Nipples are flat. Baby looked yellow to parents and they
said urine is yellow orange. Hard for me to assess his jaundice as they took
him from a yellow blanket to a white paper table top.
PE on baby normal not the greatest suck. Mom pumped 4 ounces in 20 minutes
in office. I then showed them finger feeding baby took about 1.5 ounces from
me and another half once from dad.
I gave encouragement and briefly discussed use of bottle with specialized
nipple if needed to avoid over stressing parents.
I gave them a small 2+ once bottle to use for finger feeding. I knew the
some of the stuff the ABM companies were sending my wife would be useful
somehow. Before dumping out the formula I asked dad if he had tasted the
breast milk to which he said how good it tastes. I then said "To let you
know who good your baby has it, try this" and gave him so ABM in a cup. I
tried it too. Bad after taste!!!!
The bay had a small yellow BM before leaving and while mom changed his
diaper he urinated all over. Mom laughed.
I found some chocolate to get rid of the ABM taste in my mouth and gave mom
some too. What a great way to made her feel better.
This raises three questions of mine:
1. will finger feeding help at all to get this baby to latch?
2. what are the opinions of the effects of different artificial nipples on
breastfed babies? ex. Advent, Munchkin etc are they really any better?
3. are there any post partum problems that chocolate can't as least
temporally fix?

-Rob

Rob Cordes, DO, FAAP, FACOP
Wilkes Barre PA
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