We've had lots of discussion about the colic-linked consequences of a mom
who over produces. I'll share a case presentation of a baby I saw today who
has many of the same issues as the case someone requested help on:
Baby is 6 wk pp, weighs 9lb13oz (up almost 4 lbs from lowest weight of 6lb3
oz). Baby feeds for 8-9 min. during longest feeds, with lots of slurpy
on-off, loose-lipped, lazy sucking. Digital exam reveals normal reflexes.
Test weights reveal 4 oz intake in an 8 min feed even with poor positioning
/latch and loose lips. Baby typically must be held continuously, cries and
spits after feeds, sleeps only on mothers chest. Longest sleep stretch by
day is about 20 min. At night one 4 hr stretch with rest of the day marked
by feeds once an hour. Never seems happy. Stools are watery,
mucus-streaked and copious; lots of evening colic and gas.
To complicate matters, right breast has wedge of plugged ducts, and r.
nipple has a white spot (bleb) on face at 10 o'clock. Bleb just appeared
today, so is thin looking like a blister rather than thick like a callus.
(These milk blisters very soon become dry, hard plugs at the nipple pour.)
The wedge radiates back from this duct. When nipple is gently squeezed, the
white area enlarges as if milk is dammed behind it. Nothing comes out when
hand or pump expressed.
We worked on opening the blister with a gentle scrapping of skin with mom's
fingernail. Loosened a corner, pumped, and a I gently massaged her breast
until a gush of milk finally let loose, softening but not resolving the
wedge. Our plan is to soak nipple in saline soaks after feeding to keep
wound clean, apply over-the-counter antibiotic cream (polysporin) and then
lanolin to keep it from callusing. Once we get the breast calmed down, we
will go to a one-breast per feeding period regimen to down-regulate the milk
supply. During my visit, baby was put back to first breast for another
brief feed when she got fussy 20 min. after taking the 4 oz. She only took
6 ml (by test weight) but that little cream made her very relaxed. She had
been deeply asleep 45 min. when I left.
I suspect baby nurses with such poor technique because she needs to be ready
to let go of nipple when she feels overwhelmed by flow. She doesn't have to
have a good latch because milk just pours into her mouth. When milk supply
lessened at 4 weeks and mom's breasts got more appropriately soft, mom
freaked, thought her milk was drying up, and started over-stimulating. This
threw her back into an over-production mode which over-whelmed the baby with
a foremilk-hindmilk imbalance. A feeding plan where baby can feed ad lib,
but only from one breast during each 3 hr per will cause slight engorgement,
and thus under-stimulate . Mom will down-regulate to a level of production
more appropriate to a singleton.
Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html
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