Dear Laurie,

Thank you for your time in providing your insights. Find my comments inline below:

Case 3 (possible repeat thrush) - Try "laid back" positions if baby is willing, have mom make sure she is supporting baby and breast
throughout feed, treat for bacterial infection and take probiotics.

Laid back position has been tried for several days with no improvement. She is on probiotics as well. I have not yet suggested her antibiotics for bacterial infection. Find pictures of the moms breast in the link below (If posting a link to pictures violates any rules of lactnet do send me a gentle reminder please). Its pinkish but not flaky. her breast did respond to thrush treatment first time but not the second time. the white flakes like what you see in the picture is actually yogurt used for soreness which helps a bit. 

https://picasaweb.google.com/116981295021286182011/ClinicalLactationPictures?authuser=0&authkey=Gv1sRgCIXlyKnj4qPumAE&feat=directlink

Case 2 (premie now on bottle) try nipple shield and breast compression, notice if baby has airway symptoms or difficulty pacing feeds, experiment with positions where baby's airway is in best position (extension) and/or mom's breast not obstructing in any way.

Baby wont accept nipple shield at all. Does not like prone position. Does better on supine position and does not appreciate baby body turned to side as in normal tummy to tummy hold. Baby did have stridor which disappeared after lip tie release. Feeding stress visibly reduced after lip tie release. Baby now on bodywork called Reiki. 

Case 1 ( palatal torus) Perhaps return for more bodywork for baby and mom, both have been through quite alot. Assess/increase mom's supply
make sure it is adequate. Try laid back positions where baby is prone on mom. 


How do I assess milk supply. She refuses to pump or hand express and has a slow let down. This baby also does not like prone very much she likes to be on her right side turned towards mom not even the left. Will ask mom for more bodywork. Sadly she dint have a good experience with her first CST session. We have only one CST practioner in the city. Will have to suggest some other form of bodywork. Does Chiropractic help? What about Reiki.

Thank you so much for your time.


Yasmin
MA,HDSE,CLEC,LLLL,IBCLC
www.nourishandnurture.in
Mumbai


________________________________
 From: laurie wheeler <[log in to unmask]>
To: [log in to unmask] 
Cc: LACTNET <[log in to unmask]> 
Sent: Tuesday, 17 April 2012, 22:43
Subject: 3 difficult cases
 
Case 3 (possible repeat thrush) - Try "laid back" positions if baby is
willing, have mom make sure she is supporting baby and breast
throughout feed, treat for bacterial infection and take probiotics.

Case 2 (premie now on bottle) try nipple shield and breast
compression, notice if baby has airway symptoms or difficulty pacing
feeds, experiment with positions where baby's airway is in best
position (extension) and/or mom's breast not obstructing in any way.

Case 1 ( palatal torus) Perhaps return for more bodywork for baby and
mom, both have been through quite alot. Assess/increase mom's supply
make sure it is adequate. Try laid back positions where baby is prone
on mom.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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