I heard back from the mother I posted about the other day.  She had a 3 mo
old baby dx with Failure to Thrive, and part of my observation included
identification of over-active letdown which we blocked mechanically with a
silicone nipple shield.  Within 24 hrs the baby demonstrated better
acceptance of the breast and longer nursing sessions, however, it appeared
she still was not getting sufficient intake.  I advised the pediatrician
that I thought the baby had a physical problem.  She ordered a swallowing
study and a visit with a pedi gastroenterologist.  No bowel blockage was
identified, but reflux was dx.  Baby started on meds and gained 5 oz
overnight and seems so much happier.  Mother still finds that using the
nipple shield for the first two AM feeds helps baby manage the over-active
letdown during the time of the day when she is most full, but she is nursing
without it the rest of the day.  The baby never had any spitting up, which
was one reason reflux wasn't considered earlier.  Thought the list would
enjoy hearing the happy ending.

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