Dear Friends:
       I saw a mother and her 4-week old baby at the end of January; she
wanted someone to come and check that she was breastfeeding correctly. Her baby
had been nursing so often that the mother was sleep deprived. We worked to make
lying down while nursing easy, which she didn't know how to do before.
     During that lying down feed, the baby had inspiratory stridor, and had
to have her head hyperextended while she was eating. She was swallowing; I
listened to her throat with a stethescope.
    The mother took the baby to an infant feeding specialist. The infant
feeding specialist has said that the mother doesn't have enough milk, that
breastfeeding isn't going well, and gave the baby 2 ounces of Lipil during the
initial visit, on February 10. The baby promptly threw up the formula and "hasn't
been right" (according to the mother) since. The mother has also been pumping
vigorously, because the feeding specialist said that she didn't have a good
supply. The specialist has also said that the baby has a dysfunctional suck.
    This baby, at age 7 weeks, is now THREE pounds over her hospital
discharge weight. She is sleeping 8-9 hours at night, and nurses every 1 1/2 hours
during the day. I think breastfeeding is going perfectly, and told the mother so.
The mother has been told by several medical people that she has to
bottle-feed formula because breastfeeding is insufficient.     The baby has been
thoroughly examined, and found to have both tracheo- and laryngeomalacia and reflux,
which were seen on an endoscopic examination. This is a compromised baby who
has been born to the right mother, one who has let her baby set the pace with
feeding.
    The mother is distressed because of all the conflicting advice; I told
her to take a deep breath and look at her baby when she feels that way. I also
suggested she ask for evidence behind recommendations, and then gave her the
evidence behind my recommendation for exclusive bf. This was studies about
reflux and ruling out cow milk protein sensitivity in the baby, and the benefits of
bf to a woman (also this mother who had gestational diabetes (Kjos study).
    My question is "Can this truly be a dysfunctional suck?"  Am I being
mislead by this baby's general contentment and weight gain? What am I missing?
    Barbara? Jean?
    warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE, CIMI
Maternal-Child Adjunct Faculty Union Institute and University
Film Editor, Journal of Human Lactation
Support the WHO Code and the Mother-Friendly Childbirth Initiative

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