I saw a mom with a 2 month old baby. He had surgery at a major medical
center for esophageal atresia and the speech therapist was worried about an
oral aversion because he would pull away from the bottle. He was fed
thickened breast milk because he did not swallow well. Back at home, the
mother (with the pediatrician's blessing) tried just breastfeeding him.
He's gaining weight, rarely spits up, and is active and happy.

The problem is that the mother has very sore nipples. Not cracking or
bleeding yet, but getting more uncomfortable each day. I watched during a
feeding. Baby has a really strong suck and quite often pulls back, lets the
nipple pop out and almost immediately latches back on. Sometimes he is
kinder to mom and just lets go before latching back on. Sometimes, he
nibbles his way on, sometimes latches on perfectly. Nothing wrong with the
actual suck--beautiful curved tongue, flanged lips, great jaw movement. The
other thing I noticed is that he does not curl his body up well, but has a
very subtle arch to his back. He is either slightly hypertonic or just
plain active.

He does not mind pressure at the base of his neck and stays on a little bit
longer when he is held closely against the breast. Mom also says he does a
little better at night, when she lies on her side. He does relax when put
into his snuggli. I reviewed some techniques to help him relax, including
lots of skin-to-skin contact.

When mom was pumping, she said that the majority of the milk came out in
five minutes. She has been letting him nurse for 45 minutes to an hour, but
does notice that he comes off more frequently as the time passes. I
suggested that she quit each nursing session when he starts "playing". She
will try nursing in a less stimulating environment when possible. I also
gave her a sample of purified lanolin.

My guess is that he does better with breastfeeding because he can control
the flow somewhat. He may have learned to pull away from the bottle when he
was choking and continues to pull away because it has become a habit. The
mom does not have an overly active Milk Ejection Reflex and he does not
appear distressed when he pulls away. He's a great kid and mom is very good
with all aspects of parenting; her three year old daughter is also very
active.

Anybody have other ideas? My impression is that breastfeeding is basicly
OK, but it is necessary to modify this baby's behavior before mom's nipples
get worse.

Becky Engel
Athens, GA