I'm scratching my head on a mom and babe I saw today.

This baby and mom are doing "everyting right," but he feeds at the breast
like he can't breathe.  Fusses, bobs and pulls off throughout the whole
feed.  Fretful baby face.  Sounds like he really needs to blow his nose --
but *never* sounds like that at any other time of the day, and is not coughy
or boogery.  Not a fussy baby --  until he tries to nurse.  Can drink
expressed milk from a bottle just fine.  Mom has buckets of milk; leaks
profusely.  She had a deviated septum herself that was operated on years
ago.

I don't think it is overactive milk ejection or oversupply -- although Mom
says her own mother "had too much milk."  Baby transferred 1.8 oz. in about
25 minutes of high-stress feeding, witout a lot of audible gulpy swallows.
And he isn't pinching off the nipple.   He feeds about 10-12 times daily --
so this amount is appropriate.

History:
I saw Mom three weeks ago in the hospital.  Baby was full-term, but put into
NICU to rule out sepsis.  Baby was groggy and sleepy (Day One), but could be
roused to latch.  As soon as he started to suckle, he would buck off in
frustration -- and sounded for all the world like he had a really stuffy
nose.   The neonatal nurse practitioner bulbed his nose -- no goop to speak
of.  Neonatolgist ordered nose drops that could help descrease any internal
swelling there might be.

I saw the Mom again on her day of discharge (Day Five), and she reported BF
was going much better; baby perkier; milk coming in, etc. etc.  I did not
watch the baby BF that day.

I saw her at home today (a small follow-up grant program we have for moms
with "NICU graduates") -- Day Nineteen.  Baby got some formula in hospital,
but has been all breastmilk fed since then.  He is past birth weight (born
at 7-6; was 8-0 today).  Mom's nipples are tender (all that on-and-offing?)
but not abraded.

So -- what do I ask the pediatrician to look for?  Skinny nasal passages?
This is a baby who is just NOT happy at breast.  I'm guessing he has to
break suction to breathe in through his mouth because that nose just isn't
letting enough air in.  But -- is that consistent with an ability to easily
drink from a bottle?

Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA

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