Hi All!

I have enjoyed being nomail for the last month.  Kids starting school and
so forth.  But now I have a mom I'm working with who is having a lot of
trouble and I want to make sure I am not missing anything.

This is the moms second baby.  First baby nursed for 9 mo. no problems.
This baby born 9-15-98.    7 lb 12 oz at birth, 9lb 7oz yesterday.
Obviously, no weight gain problem!!!  Plenty of wet diapers and normal
bowel movements.  Mother called with complaint that baby is very gassy,
seems to be in pain, nipples on right breast sore, arches and pulls away
while nursing on right breast.  I observed the nursing couple.

I found:  Baby is latched on okay on the right breast.  Mouth could be open
a little wider, but not much.  Mother not feeling pain at latch.  Baby
nurses like he is in a race; very fast sucks, swallowing from the first
suck, sounds like and looks like he is working very hard.  Mother is
dripping milk from the start.  After 2-3 minutes, baby loosens the latch,
slips down the nipple (mother feels pain at this point), baby pulls off,
cries, pulls legs up, struggles, gasps.  Mom is squirting milk all over the
place.  Baby is calmed after a couple of minutes and I suggest that mom put
him back to the same breast.  Repeat performance.  After
nursing/struggling/calming in this manner 3-4 times, baby will settle for a
while at the same breast.  He only does this from the right breast.  When
nursing from the left breast, he does not exhibit this behavior.  Mother
does say that her other baby seemed to struggle a little with the right
breast too, but nothing like this.

I suggested:  Nursing one breast per feeding.  If baby ends feeding and
wants to eat again in 45 min. or less give the same breast.  Nurse
reclining with baby's head/mouth higher than the nipple.  Nurse with baby's
face in to the breast.  Take baby off when let down occurs, express by hand
past the initial fast flow.

The mother tried these suggestions for 2 days and does not want to nurse on
only one breast per feeding.  She is afraid her baby is getting too hungry
this way.  She was very discouraged so I recommended 2 LCs.  She met with
one and was given the same info with the addition of trying a cross cradle
hold.  Another spoke to her by phone and suggested that she try nursing the
baby on the left(good)breast and slide him over to the right breast without
changing his position.

My questions are:
1.  Does this sound like overactive let-down?
2.  Any additional suggestions of possible diagnosis or treatment?

additionally, the mother and baby have been diagnosed w/thrush by the one
LC who saw them yesterday.  The mother has been giving Mylicon drops on the
recommendation of MD, 8 times per day, no effect.  Baby was jaundiced.  It
peaked at 17.8 on day 5. no intervention.

Any help is most appreciated. Mom says she is ready to quit.

Thanks,
Laura Barmby
Maryland, USA
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