Dear Heather:

I'm sure she appreciates your trying to line up hands-on help for her -- moving is always stressful enough.  The ILCA website has a "find a lactation consultant" feature.  She needs to find someone good  -- with an older baby there are always so many variables to untangle.

What is "gaining ok"?  Sometimes when a baby is scraping by gaining 3-4 oz. a week, they may not have the oral strength to remove milk well -- getting a baby gaining robustly may help them use their anatomy much more effectively.  And when a baby isn't removing milk well, feeding more frequently does not turn the situation around (100 x 0 is still zero).  And ineffective milk removal lets the supply down-regulate, making it even more effortful to remove milk.  The mother is caught in a very difficult cycle of near-constant feeding -- the milk transfer is like an IV drip.  (And these babies tend to be very charming because of all the touch and interaction, so you can point that out, so she knows that some good has come of her efforts).

The pump and supplements can help break that cycle -- to boost the supply and boost his weight gain so he can take the job back more effectively.  She continues being so responsive to the baby, but keeps the feeds short and active, with lots of breast compressions and switch nursing from side to side -- and declares him done when he has stopped swallowing, so that she can wedge in pumping sessions after as many of the feeds as is manageable -- the baby has done what he can do for that feeding and she brings a fresh player in off the bench to continue the game.  (Or she can pump the other side while he is feeding if that works better for her).   She gives him that milk very freely --this would be a great case for supplementing at the breast, perhaps rigging up a home-made supplementer, with a feeding tube in a bottle.

Getting off the nipple shield would be a great step forward for this team.  The shield is great tool sometimes for initial latching difficulties to get the baby oriented to the breast, and may especially help a newborn who just wants an ounce or two, perhaps more easily obtained during the initial engorgement. But the tool needs to be introduced with a plan to wean it out of the picture.   At two months, with the mother's body calmed down (and perhaps down-regulated by the baby's milk removal difficulties) a nipple shield, still dribbling out the milk at a slow and steady pace, can really interfere with a baby needing to get 2 to 4 oz. at a time.  (And supplementing at the breast is really not very practical with the shield).

To compete with the unnaturally firm oral signal of the nipple shield, the mother may need to really exaggerate the latch to trigger the suck, with a deep, wide "sandwich" of breast, a la Rebecca Glover.  Perhaps starting the feeding with the shield and slipping it off mid-feeding when the nipple is drawn out and milk is flowing.  Yes, she may need further help with finding other feeding therapists --feeding is such a complex process, and she may need a lot of resources -- but I have seen people with slow-gaining babies going down the rabbit hole with multiple oral-tie releases and bodywork, and no one has shown them some ideas on helping the baby whomp in a big mouthful of breast.

Obviously, wishing I were in Tennessee to try to help!  Good luck to you in your work.

Margaret Wills, IBCLC, Maryland


> Date:    Sat, 14 Oct 2017 17:03:19 -0400
> From:    Heather Bradley <[log in to unmask]>
> Subject: Request for breastfeeding support in Dixon County, Tennessee
> 
> Hi all!  I have a mama who is moving home to Tennessee in the next couple
> weeks, and baby is having some feeding dysfunction.  Scores low on ATLFF
> but does appear to have facial asymmetry/tongue elevation.  Now two months
> old and only transferring 1-1.5 oz a feed despite use of nipple shield and
> mom doing breast compressions.  Baby is gaining okay but nursing every
> 30-60 minutes to do so.  Mom has been unable to pump because of feeding
> "schedule" but was able to pump 1.5 oz from one breast when baby was
> eating.  Baby is also having exclusively green stools at this point.
> 
> As she is leaving our area soon, I want to find her help before she goes.
> If anyone is in the area or knows someone that would be helpful for this
> young family, can you please contact me?
> 
> Much appreciated!
> Heather Bradley
> 
>      

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