I recently re-connected with a mother who I worked with when her infant son
was first born.  Briefly, Mom was G1P1. Baby was 36 wks,  5lb6oz (2 oz below
birth weight) on Day 12 at the time of my 1st visit.  Mother had very sore
nipples.  Re-positioning, breast compressions, kangaroo care, etc. employed.
Baby had really good facial tone for a "just a little early" baby, and
transferred 1.7 oz during the feed I observed, so I suggested fewer
interventions than I typically do for this scenario.  However my optimism
was somewhat misplaced.  When I returned for a weight check 6 days later,
baby had only gained 2 oz.  At that point I instituted insurance pumping,
postfeed supplements of hind milk, etc. This quickly resulted in a 2 lb gain
over the next 4 weeks. (No formula was ever used.)

But more to the point of this post, which is about excessive infant crying:
At that 2nd visit, mom complained that baby seemed excessively fussy -- esp.
during diaper changes.  I was inclined to lay the blame on hunger, but
watching her diaper the baby, he did seem really troubled by certain
movements.  I showed the mother how to diaper baby on his side rather than
jackknifing his legs to wipe his bottom. I also demonstrated how burping in
a more open body position was more comfortable for him than bending him over
his diaper waistband. My report to the peds described the baby's distressed
and uncomfortable behavior and sensitivity around testicles and abdomen.

  Over the next few months, he never seemed happy.  This was a source of
concern to the mother, and to me. Crying is a significant stress cue, and it
is stressful to parents to hear their baby cry.  There is a reason babies
cry, even if we can't identify it.  I lost touch at about 2 mo. when the
baby's growth seemed stable and there was no clear reason for me still to be
making followup calls.   Just a few weeks ago, the mom phoned.  She wanted
me to know that the baby had his 1st birthday and she had reached her bfg
goal and  was weaning.  She also told me that shortly after we stopped being
in close contact, the baby stopped gaining weight and began passing very
green stools.  He was intensely fussy, and they took him to the ER where
something called an "incarcerated hernia" was discovered.  The baby had
surgery to repair this.  He still has some fluid on his testicles, but will
probably be fine in the end.

I think back to the distress he manifested during diaper changes when
increased abdominal pressure must have aggrevated that kinked gut and how
all that crying was a warning signal.  This is just one more story among
many I've seen where a mother had a 'knowingness' about her baby, and where
the baby was trying to tell us that something was hurting him.  I don't like
to reassure moms too much who have those intuitions that something is amiss.
I like to validate her and tell her to assume a watchful waiting posture.
Because generally things get better or they get clearly worse and you know
that something really is wrong.  I like to think the fact that this mom hung
in there with breastfeeding was a big part of how well his gut healed after
the surgery and how robust he is today.

I guess this is also a story about how active management of the 36 weeker
can assist a good bfg outcome.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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