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Subject:
From:
Barbara Latterner <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 13 Oct 2014 08:11:19 -0400
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Allyson,
 
It sounds as if this baby is not comfortable with feeding.  I would  
definitely rule out tongue-tie, especially since her first baby had issues and  
there is a genetic link with TT.  Not questioning your ability to diagnose,  
but you said you did a suck assessment and didn't mention going under the 
tongue  to elevate it and this can reveal those sneaky ties.  If there is no 
tie,  I'd consider possible birth trauma and assess infant's structure and 
ability to  use both sides of his body equally, especially upper body and head 
and  neck.  Rule out difficulty here, and then consider mother's diet and  
possible sensitivities in baby.
 
Swallows normally are not associated with squeaking nor should swallowing  
be gulping nor noisy.  This can indicate difficulty handling a bolus or  
malacia.  The thrush is often associated with tongue-tie or  
sensitivities/allergies.  Sounds to me that baby is nursing to eat but due  to his discomfort 
with the process won't stay at breast for leisurely feeding or  comfort.  Of 
course this type of feeding contributes to infant and mother  stress and 
down regulation of supply over time.  Would also consider mother  and baby 
probiotics.
 
Hope this is helpful and that once the cause for feeding difficulty is  
found and addressed, mother and baby can enjoy breastfeeding.
 
Barbara Latterner, BSN, RN, IBCLC
 
Permission to post: Mother (g1p1) in to to visit because infant has been  
increasingly fussy over the week. Mother felt that breastfeeding had not 
started  off well and that infant did not have a good latch. Infant now 6 weeks 
old. 3  weeks ago they had both been treated for thrush. It was this last 
week after  treatment stopped that infant had been fussy. She also has seen 
infant spit up  more. She has pumped occasionally. Once in the evening she 
obtained 3 oz. Once  in the morning after  a feeding, she pumped for only 5 
minutes and obtained  a total of 3 oz. She stopped after 5 minutes because the 
spray stopped.  


Mother breastfed her 1st child but stopped due to what she thought  was low 
supply. Infant started to have slow weight gain and long story short her  
peds told her to go to formula. She was a victim of poor advise and common  
misperceptions.  She was not successful with pumping to keep supply up with  
1st. She has since switched peds.


Infant's birth weight was 8#7oz and  at 3 weeks was 9# 13oz. The visit with 
me @ 6 weeks was 11#1oz, which I  calculated was slightly smaller than 1 oz 
a day and certainly slower than the  1st 3 weeks.


Suck and palate assessment all normal. No TT  noted.


At breast, infant fed calmly for 5 minutes before pulling off.  Mother had 
been noting infant doing this more and more, fussing after several  minutes 
but would return to breast for a couple of more minutes. She felt that  
infant would have a squeaking sound with feeding. Infant would not return to  
breast after the 5 -7 minutes but would just fuss at mother. I perceived the  
squeaks to be swallows. Infant did not look to be in distress and seemed to  
handle the feeding easily. However, infant did have a good crying spell for 
over  10 minutes in my office before calming. She did return to breast a 
couple of  minutes each side more.


Mother has only used cross cradle so we tried  straddle hold and I did not 
hear many swallows. Once returned to cross cradle,  at other breast, infant 
had loud swallows again. Over the course of the feeding,  infant took 3.2 
oz. He did have some spit up but not large. 


I am  working on the theory that this child had gotten used to mother's 
possible  strong MER, hence the perceived poor latch and big weight gain in the 
1st 3  weeks. Now infant is fussy when MER is slower.  I wondered about 
possible  sore throat r/t thrush?


Mother asked about herbs, such as fenugreek  but I am not sure that is the 
way to go.


What jumps out at anyone  else?


TIA,


Allyson Michaels, RN, IBCLC
Charlottesville,  VA



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