I have the patient's permission to post to this list serve.

Very large breasted mother with treated hypothyroid condition and inverted
nipples saw me at 4 days postpartum.  Her healthy full term baby boy had yet
to successfully latch.  He could not maintain suction to stay on.  There is
no problem with a wide gape.  Baby received this and supplementary ABM by
finger syringe.

 "Latch Assist" was successful to draw out both nipples briefly but still
this little one could not stay on and was becoming increasingly frustrated
and crying hoarsely.  Suggested using a breast shield after describing the
difficulty some have with coming off this device.  Mom and Dad were willing
and baby then latched on and nursed for 20 minutes straight, taking 1oz. of
milk.

Five days later they return because Mom describes very sore nipples.  The
baby has continued to lose weight and now has a 7% loss.  This is the point
that the pediatrician wants supplementation to begin.  Mom and Dad agree to
give either pumped milk or ABM by syringe.  Adjusted positioning alleviated
nursing pain.

What has me mystified is the diapers counts.  This baby has 11 wet diapers
and 6 BMs in 24 hours.  Stool is normal, soft, yellow, curds.  Advised mom
to have her thyroid levels checked again.

Other ideas?  What have I missed?

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