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From:
Jennifer tieman <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 4 Jan 2005 23:43:26 -0500
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I have an interesting mom-baby pair in my practice.  I first met the mom
shortly after she weaned her previous child at around 9 mos.  That little
guy had been followed by my partner from birth.  He was exclusively
breastfed for about the first 3-4 mos, but was always slow to grow and
hovered right at or a little below the bottom of the growth chart. Partner
encouraged supplementation and early solids (don't get me started), and baby
did not grow any faster with these interventions.  He also had developmental
delay, which became more evident around the time I started caring for him.
Thorough work-up revealed that this baby had suffered a left middle cerebral
artery stroke somewhere along the line - perhaps even prior to birth.
He is now receiving early intervention services, and doing quite well -
walking with a limp, talking well for age, and appears to be compensating
well.  He is still small, although quite healthy, hovering around the 3rd
percentile for weight and height.  Mom has some feelings of regret and anger
over his weaning, since it turned out he had a medical issue not related to
her breastmilk likely causing his slow growth.  This was the issue that led
her to switch to me as a provider.

Mom has a new baby now, about 2 mos old.  Baby was born at 38 weeks,
spontaneous labor and delivery, 6 lbs 9 oz. She has had adequate growth from
birth, averaging about 1 oz a day, and at 2 mos was 10lbs 14 oz.  She is
exclusively breastfed.  From birth, she nursed well and frequently.
Starting around 2-3 weeks of age, mom says baby is irritable at breast
several feedings a day.  She arches her back, cries, and will latch and suck
briefly, then cry again.  Mom describes her letdown as forceful this time
around (wasn't with first baby) and baby is heard gulping and sputtering
especially at morning feedings.  Baby is more irritable, and spits up a lot
more than first child did (no projectile or large volume vomiting though)
Some times of the day, baby is happy and content, and nurses eagerly and
happily, though.  At around 5 weeks, baby started to have most feeds be
difficult - arching, crying, refusing to latch, than rooting desperately,
sucking briefly and crying again.  Stool output decreased around this time,
too.  At this point, I wasn't certain exactly what the problem was, but mom
was worried most that baby was arching and refusing to eat, and then
spitting more than her other child.  We talked a lot about options for
treatment, and after careful thought, we decided to try a trial of Zantac.
Baby then slowly improved over the next week, and started to nurse happily
again.  Stools picked back up to nearly every feeding also.  At 9 weeks (2
month visit) mom reported that for the last few days baby had been back to
refusing to nurse sometimes, and arching her back and crying again.  We
weight-adjusted her Zantac dose again, and will see how this works.  After
all the recent discussions here, though, I've discussed with her trying an
elimination diet, too, and she is thinking about trying to eliminate dairy
and see if her symptoms improve.
So what do you all think?  One of those rare, true refluxers? Another issue
and the Zantac timing was serendipitous?  The mom doesn't really want any
diagnostic tests at this point, and since baby is growing well, I can't
disagree with her.  Thought I'd think it out loud here though, and see if
there were any other prevailing opinions!
Thanks in advance!
Jennifer Tieman
Family Physician
Mom to 4, including my toddler nursling Caroline Rose

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