Barbara writes:  So now what do we do?  This Mom is fabulous.  No whining,
willing to try anything, even to continue in pain, but that's not good
enough.  I don't know
why W. is changing his sucking pattern after a few minutes.  I'm beginning to
wonder if there might be some neurological underlying problem, but getting
the pediatrician to address this is unlikely at best.

Barbara, you mention that the baby has trouble coordinating suck, swallow,
breathing. I have seen babies who can hold it together for a minute or two
and then lose their coordination.  One little girl I worked with could nurse
for 3 or 4 minutes and then was totally uncoordinated--did the same thing on
a bottle.  It seemed she had 3 minutes of suck/swallow/breathing coordination
and even then it was shaky and then she lost it.  The baby also had
stridorous breathing and I believe was aspirating with every feeding.  I
never did convince the pediatrician to work this baby up because she was
gaining wt. She was gaining wt. because mom fed her for 5 minutes every hr. I
suspected an airway problem or a neurological problem.  We did have one joint
lactation/OT consult and the occupational  therapist felt the baby had
sensory integration problems. The interesting thing to me was that the baby
acted totally normal except when feeding--cuddled in nicely to her mother.
Right from birth she had a wierd, uncoordinated suck.  There was nothing
noticably wrong with the oral anatomy.

The baby you are working with may slip down on the nipple and pinch to slow
flow because he can't coordinate things any more or he may be sucking in
cheeks and pinching as a compensatory mechanism to hold onto the nipple.
These cases are so complicated.  Also dents in the forehead from forceps
sounds like a pretty rough delivery. The upper airway congestion may be milk
going in the wrong direction because this baby can't coordinate swallowing.

Sorry I don't have any great advice for you, except maybe an OT consult to
evaluate feeding, if you have access to OT services.  Let us know how things
turn out for this baby.

Kathy Boggs, RN, IBCLC
Mountain View, CA

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html