I saw a Mother and baby yesterday that really has me perplexed. Baby was

36 1/2 weeks at birth, now 3 weeks.  Mom breastfed about half the time
and bottlefed breastmilk half the time because attachment is such a
challenge.  That and sore nipples are what brought her in.  Baby had
eated 1 1/2 hours before the consult.  What struck me about this baby
was his behavior.  Mom undressed him for a weight and he immediately
started grunting.  I thought he was going to poop, but he kept grunting
the entire visit.  I asked her if he did that all the time and she said
yes.  Although he sucked on my finger (flat tongue, up and down motion
to suck) he wasn't interested in the breast and arched a lot.  When he
would stop grunting any stimulation got him going again.  I tried
swaddling, which made him fall asleep and then just flexing his body,
but he never rooted wide enough to get a good latch and just really
seemed not interested.  My main question has to do with the grunting and

arching. Has anybody ever seen this before?  I actually encouraged her
to see our team of therapists (PT, speech, OT).  Any words of wisdom or
experience?

As far as the breastfeeding went I did encourage her to wean him from
those bottles because his weight gain had been great and she reported
swallowing and softening breasts with breastfeeding.

My need for a pep talk has to do with my outpatients.  It seems if
things don't turn around immediately they give up. I try to get a sense
of what they are able to do and what they are open to, and I try to give

them realistic expectations.  But in 7 years I think I have had one or
two Mother  who I really felt like stuck with it for the long haul.  But

most of them, it seems when I call them to follow up ( generally in 1-6
days) they have given up.  Is there another approach I should be taking
or is this just the way it is?  We have a pretty well educated
population and about 90-95% of our Mothers initiate breastfeeding in the

hospital.

Andrea Tran RN, IBCLC
Boulder, CO

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