This is all very interesting on both the descriptions of these babies and  
the theories to why they act this way.  
I truly believe if a newborn is crying often and having difficulties being  
comforted, they are trying to tell us about their pain.  What I hear from  
staff is that these babies are "starving" and the poor mothers feel their babies  
are rejecting them.  
Many times these babies are content with being held, rocked and not  fed.  
I had a case yesterday where the baby was the result of a long labor that  
arrested so the mother ended up with a c-section.  The first time I am  seeing 
her is on day 3.  The baby is down 10% from birth weight and the  pediatrician 
has already told the mom that the baby has to be supplemented after  each 
breastfeeding.  
Mom describes that all breastfeedings have been difficult.  The baby  cries 
at the breast and it takes anywhere from 15 to 30 minutes to get the baby  to 
latch.  The night before I saw her she described that her baby refused  to l
atch on several attempts and finally latched by 6 AM.
When I arrived the baby was sleeping in grandfather's arms.  Placed  the baby 
skin to skin on mom's chest and reviewed the states of babies.   When her 
baby moved into light sleep, I had mom gently stimulate her baby to  quiet alert. 
 Then mom moved her baby to the clutch hold.  Once the  baby left mom's chest 
and moved into this nursing position he started  crying.  Mom hand expressed 
her breast milk but baby not interested.   His crying escalated, so I had mom 
try to offer her finger.  Baby refused  to suck on mom's finger.  The only way 
this baby would stop crying was when  I picked him up and walked him.  Than I 
had mom try a side lie position but  baby only arched and screamed.  By this 
time mom is in tears asking for  formula.  She was not interested in 
expressing her own breast to give her  milk.  I did not feel comfortable with having 
this mom bottle feed this  baby and wanted to observe how this baby would 
respond so I started the bottle  feeding.  The baby continued to cry with any 
attempts to feed him.   Touching of the bottle nipple near his lips or the smell did 
not calm him.   He would not suck on a pacifier either.  Finally I tipped the 
bottle down  so baby only had the nipple in his mouth but no fluid in the 
nipple while I  waited for him.  He eventually started sucking, than I gently 
allowed some  formula into the nipple.  I used paced bottle feeding and he 
controlled the  flow at his own pace.  What was interesting is that he held his 
hands in  tight fists over his eyes during the whole feeding.  As he became 
calmer, I  gave him to mom to finish the feeding.  I encouraged her to keep the 
doors  open to breastfeeding and/or expressing her milk.
I wonder what made this baby so hypertonic and fussy?  I could  theorize his 
birth or even too much effort by others to get him to nurse.   Than there is 
the growing tension that mom was demonstrating.
I have no answers just observations.  I do believe this baby is  looking at 
long term feeding issues if his problems do not resolve soon and the  
appearance that a bottle can be put into his mouth is not necessarily a good or  safe 
solution.
Ann Perry, RN, IBCLC
Boston, MA



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