Dear Jennifer,

I suspect, as you do, that birth trauma is involved.
In our hospital, we have a protocol for observing
infants who have a vacuum-extraction assisted delivery
because of the increased risk of bleeding.  I'm at
home right now so I don't have the flowsheet in front
of me, but I believe they can have various types of
bleeding from intracranial as well as tearing of blood
vessels in the scalp.  It consists of measuring vital
signs & frequent physical assessments looking for
signs of shock & central nervous system irritation.  A
big red flag is poor feeding skills.  If an infant has
a certain number of signs show up, he will be
transferred to the Level II nursery for closer
observation & testing which generally includes a
cranial ultrasound & possibly a CT scan or MRI.  I
don't know how many other centers follow a similar
protocol, but I would probably ask the pediatrician if
he'd considered the possibility of a bleed
contributing to the infant's abnormal feeding
behavior.  Luckily, our center is willing to delay
discharge until feeding is going well.  If it isn't
accomplished in 24-48 hours on postpartum, the mom &
babe come to room-in on pediatrics if mother no longer
requires hospitalization.

As for the nipple shield use, if it helped preserve
the breastfeeding relationship while the root cause of
the feeding difficulty was worked on, I'd probably be
for it but would want to maintain close follow-up with
this dyad.  I hope the other LC involved is willing to
keep you posted on this infant.  I'd like to know the
outcome.

I like chiropractic care for myself, so I wouldn't
have been upset to have the child seen by a competent
practioner once it was determined that there was no
hemorrhage involved.  It would seem, IMO, to make a
good next step.

Sincerely,
Linda Madsen RN, IBCLC

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