Pam
This is a challenging case and the first thing I thought of was some sort of
oversupply and overactive MER perhaps coupled with a suck/swallow/breathe
problem like a swallowing disorder. The reason I came up with this is that
you mentioned reflux, Maalox, weight gain is "very good" which seems odd if
he's not eating alot or signaling, but does go along with a very large
intake in a short period which can be quite uncomfortablef or the baby.
Perhaps an oversupply or OAMER developed and that's when baby exhibited s/s
and then outright refusal. I am not surprised that baby's wt gain is now
faltering and her supply may be also. How is she maintaining supply? Perhaps
mom could rent a scale so that she can gauge intake, since baby is may very
well NOT bf during a consult.
I would suggest good positioning to maximize baby's airway function and own
head control and also a swallow study or some assessment like that.
Laurie Wheeler, RN, MN, IBCLC
Mississippi, USA

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