Has mom tried "coating" the nipple area with breastmilk? Sometimes this
helps baby get the idea of, "This is where I'm supposed to eat.".
Possibly an SNS might help here to get baby used to taking feedings at
the breast? Also, does baby seem frantic in refusing the breast?
Possibly, baby is impatient for let-down?
Tammy Schilling
LLL Salisbury, MD
Liz Brooks wrote:
> With permission to share her case, here are the details:G1P1,
> non-eventful vaginal delivery of full-term 7 lb 14 oz baby girl on
> 3-30-01 (6 days ago) Some suctioning at birth, some meconium
> staining. Baby did not latch in delivery room -- and not at any time
> during hospital stay. Discharged at 7 lb. 4 oz. Baby acts, for all
> the world, like a "nipple confused" baby -- yet she's never had a
> pacifier or a bottle. She purses her lips and pushes Mom's nipple out
> of her mouth. Mom positions baby well, and forms breast well. Mom
> attended pre-natal BF classes; is calm and well-motivated; was
> double-pumping and cup feeding by the time of discharge. My digital
> exam indicatd a nicely arched upper palate, a tongue extending nicely
> over the gum line, a lovely "tongue wave" motion toward the back of
> the mouth, and a baby who was perfectly and happily content sucking on
> a finger. Baby doesn't appear to be "sucking her tongue." Baby is
> alert during "feeds." Relevant? Baby was fitted for a "hip harness"
> on Day 5; does not appear at all uncomfortable in it according to
> Mom. Mom has been able to comfortably position baby to "breastfeed"
> in the cradle and football positions -- but baby, of course, isn't
> nursing. Mom had been offering breast first at each feed; trying to
> latch until she or baby got frustrated, then offering cup-feeding of
> expressed breastmilk. I suggested feeding a bit first (1/2-1 ounce),
> then offer breast. With this technique, baby was much more willing to
> "hang-out" at the breast ... mouthing nipple, perhaps latching briefly
> with no suckling. But Mom had to return to cup to give baby
> enough. At the hospital, she had tried a nipple shield. If anything,
> Baby fought latch more. Mom's nipples stand out with areolar
> compression, and her breasts are not engorged. Other suggestions I
> gave her:* Lots of skin-to-skin contact.* Try bathing with the baby in
> a warm tub (she didn't get around to this before the harness was put
> on -- I do not know yet if the baby can be immersed).* To get the 2.4
> ounces of breastmilk baby needs (assuming 8 feeds/24 hours), try
> finger/syringe feeding. (Mom reports that feeds do go a bit quicker
> -- and more is taken in -- using this technique. Baby had been
> getting about 1.5-2 ounces per feed .... just not enough according to
> my handy-dandy Kitty Frantz pocket charts).* Climb into bed with baby
> at every opportunity.* Remember the goals: (1) feed the baby [being
> done], (2) protect mom's milk supply [being done], and (3) stay sane
> [she seems to be scoring here, too]. So, what else -- if anything -
> can I suggest? Liz Brooks, JD, IBCLC
> Wyndmoor, PA, USA
>
>
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