I promised Arly I would relate my 2nd challenging "refuser" case and I've
finally read all my messages with some time left over. So, at risk of
becoming very long-winded again, here goes. I will try and be concise.
Baby girl born 20 Jan. wgt 3458 gm (7-10) 75th%ile, lgth 53 cm 95th%ile.
Full-term, vag. del. with epidural. BFing initiated 8 hrs. after birth.
Mother stated no partic. reason for delay, that was just when they brought
baby for 1st feed. Baby not interested & would not feed. Fell asleep
@ breast at every subsequent attempt. @24 hrs. formula by cup started. D/C
home @ 48 hrs., baby wgt. 3178 gm.(7 lbs). Mother started pumping.
3 days: L.C. visit - Doll's Eyes Tech. used to rouse baby but no rooting
and no sustained latch. Baby did not cry at all even with repeated
attempts at latching. Baby then fed EBM by bottle demonstrating proper use
of ortho. nipple. Recommendations: Waken & feed q.2-3 h. by day and feed
as baby wakens @ night, ensuring min. of 8 feeds/24 hours. Attempt
latching @ breast max. of 15 minutes @ each feed. If not successful,
bottle feed, then pump x 15 min. with double set-up. M.D. to be seen by 1
week.
10 days: L.C. visit - no latch since last visit. Seen by family M.D. @ 7
days -back to birth wgt. Tried at breast and after many attempts baby did
latch in cradle position and sustain latch, nursing well for 15-20
minutes. Several positions and many more attempts resulted in 2nd latch on
2nd breast in lying down position. Same recommendations as before. Baby
still not crying but did stir x 1 in previous 2 nights.
14 days: L.C. visit - no latch since last visit. Occasionally baby mouths
breast during attempts. Managed one latch after many attempts but baby
was extremely lethargic. Bottle feed of 60 ml. following was very
"forced". Same recommendations plus referral to breastfeeding supportive
ped. for full phys. exam and assess.
17 days: Ped. visit - wgt. 3370 gm (7-6). Mother states Ped said she'd
never seen baby like this before (very experienced Ped.). Concerned re
wgt loss since visit to Fam. Dr.. Sent baby for blood work and
urinalysis, told mom she had to get more food into baby.
21 days: Ped. visit. wgt. 3515gm(7-12). Ped. happy but no suggestions. All
tests normal, no reason for lethargy. Parents had worked very hard to increase
intake but all feedings forced. Mother had gone to a PHN Breastfeeding
Support Group but was so upset to see the diff. between her baby and
others that said she couldn't go back. PHN unable to help latch baby.
25 days: L.C. visit - still no latches - less lethargic, easier to feed by
bottle. Tries @ breast but does not succeed. After many, many attempts
managed 1 successful sustained latch. For 1st time, baby became upset and
frustrated during tries and actually cried - not much, but some! Before
baby just shut down. This time she stayed alert. Recommended mom carry
baby in upright position on body as much as possible - only put in bed
when absolutely necessary.
26 days: L.C. visit. Baby more willing to latch so tried Lact-Aid with 75
ml EBM in bag. Hallelujah! Baby latched and emptied bag - lost latch as
soon as bag empty but seemed satiated. Recommended no bottles for 48
hours. If Lact-Aid @ breast does not work, finger-feed with Lact-Aid tube.
53 days: L.C. visit. Baby has been BFing without help of Lact-Aid x 7
days. Wgt. @ 7 weeks 4422, lgth - 58 cm.(25th%ile wgt. for lgth). Mom
experiencing some discomfort @ latch-on and nipples wedged and blanching
after feeds. Slight changes in positioning relieved discomfort as did
getting mom to stand up, walk about and sit in different places during
feed - much more relaxed by end of feed.
62 days: Pump returned. BFing going well, no discomfort. Baby cooing and
smiling. Mom active, going out with baby to badminton games, exercise
classes, etc. helped friend with BFing!!!!
Comments: I wondered about cranial compression after seeing Martha's post
re cranio-sacral therapy. I was not able to find anterior fontanel at all
at first - bones were meeting completely. I noted it to mother but M.D.s
did not seem to think it was abnormal. I still wonder if this baby will
be completely normal long-term. I am certainly going to try and visit her
at 1 year.
Any thooughts, anyone?
--
******Joan M. Fisher, RN, BN, MEd, IBCLC******
***********Ottawa, Ontario, Canada************
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