Hi Riva

Long inefficient feeds, lasting an hour, can be 
characteristics of a baby who is really not 
getting enough milk. If baby had a frenotomy two 
weeks ago and he is now 10 weeks, that could mean 
that he had 8 weeks of breastfeeding 
ineffectively, to depress mom's milk supply, and 
the effect of the frenotomy -  by itself - is 
unlikely to have provided what it might take to 
boost it up to provide enough for the 
baby.  Often babies who are  struggling will feed 
for hours, but there is little swallowing.  They 
will doze a lot, or breastfeed with the eyes 
closed, or seem happy until taken _off_ the 
breast when they will wake angrily and still show 
signs of wanting more.  Then they'll take a few swallows and doze again.

You say that in the end the baby does get 
satisfied and is gaining weight normally.  Could 
you let us know what his weight checks show?  I 
find it helpful to know the birth weight, weight 
at 3-5 days, and then weekly, if 
possible.  "Normal" weight gain at this age 
should be round about 30g (1 oz) per day.

Meanwhile, techniques to help the baby get a 
larger volume of milk in a shorter time could 
include breast compression in the pauses between 
sucking bursts to stimulate easier milk flow (ie 
when he pauses and stops swallowing and closes 
his eyes, squeeze the breast very gently near the 
back so as not to disturb his latch, and watch 
him start swallowing again).  The mother could 
also try switch-nursing (swopping breasts when 
the baby stops swallowing on one breast)  It's 
perfectly fine to use 4 breasts per feeding, or 
even more and it gives the baby more milk with less effort.

Depending on the baby's weight, it might be a 
good idea to stop an inefficient breastfeed after 
half an hour, for the mom to express what the 
baby has left behind and feed it to him as a 
supplement after the _next_ breastfeed.

It sounds to me like this baby is showing many of 
the signs associated with inadequate weight gain 
(which means inadequate milk intake) and I'd be 
really interested to know what the numbers show.

Pamela Morrison IBCLC
Rustington, England
----------------------------------------------------
Subject: long inefficient feeds

Greetings!
I am working with a Mom and her 10 week old baby. 
Mom has improved the milk supply and her 
technique. Baby had a frenotomy two weeks ago. 
Baby still takes long meals  (about an hour) with 
lots of stops and starts, occasional clamping 
down. Frenulum was checked after a week,  by 
surgeon, who feels it was open enough. I still 
haven't seen it. Baby will not suck on finger to 
do any suck training and mom feels he "doesn't 
like it". After all, baby does get satisfied and 
is gaining weight normally. Mom is very concerned 
what will be when she goes back to work, when she 
will not be able to dedicate endless hours to 
feeds. I was thinking that the next step might be 
CST – though there were no birth interventions, 
no asymmetry or other reason that I would usually refer on.
I would appreciate your input, I am not sure i 
have given enough details, what have I missed?  What might be the next step?
Thanks for being there!
Riva

Riva Weissfish BA, CCE, IBCLC
Childbirth Preparation, Lactation Services and Parenting Workshops


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