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Subject:
From:
"Ibolya Rozsa, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 24 Oct 2003 01:13:05 +0200
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On Oct. 10th, Rachel forwarded my request for help to LN. I would like to
say thank you to all who replied on the list and privately. I tried to send
replies privately, too, but some of them came back due to server problems.
Here is my report on the case:

I visited the family again and to my surprise the baby (6 weeks) was not
sucking my finger. Only licking and biting with his gums. He kept pulling
his tongue back. When he latched on the breast he was doing quite all right
while milk was flowing, then he pulled his tongue back, made clicking sounds
and started chewing and biting. And this baby was nursing well a couple of
weeks earlier!!!We tried different positions, it was always
the same. We tried the sandwich-hold to get the breast deeper in baby's
mouth. It was a better feeling for the mom, but baby did not like it at all,
started choking. And baby did not seem to like mom's left breast. I checked
the baby's mouth very carefully, I tried to find out if his ears or neck
hurt but found nothing. (I suggested the parents to have a doctor check as
well.) And he was not drooling at all and I didn't feel teething was an
issue at the moment.

I told the mom to try to deal with what we had. Let baby bf while milk is
flowing (we say it in Hungarian that "he is swimming on MER") and take him
off as he starts clicking and biting. Let baby bf while asleep. I left them
with a feeding cup in case baby refuses the breast again.

Two days later mom called saying that she was ready to give up. Her nipples
were hurting badly and baby was not bf correctly not even at MER. From the
type of pain she experienced I suspected it was candida. Due to the pain she
didn't put the baby on the breast anymore, instead she gave him EBM from a
bottle. (She was not comfortable using the cup.)

I must admit that at that point I started to question my own knowledge. What
did I do wrong? What did I miss? Was there something I payed no attention
to? I kept thinking this case over and over again and found no answer.
I consulted with two Hungarian LCs. One of them is a neonatologist. And what
a coincidence this mom visited them on the same day in the hospital to have
them check her sore nipples. The doctor checked the baby and found nothing
wrong except that he did not want to nurse correctly. They were just as
puzzled as I was. They told the mom the same things I had told her and took
a sample of her milk for candida test. She was also prescribed an ointment
called Pimafucort (natamycin + neomycin + hydrocortison).
About 4 days later her nipples were much better and when she put the baby on
her breast it didn't hurt and baby was nursing well!!! No clicking! No
candida grew in her milk sample.
I am puzzled!

Ibolya Eva Rozsa, LLLL, IBCLC
Hungary

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