Dear Collective Consciousness,
I have two puzzling cases to place before you...
1-  Mother of 4 wk old with (perceived?)milk insufficiency.  1st inf slow
to gain mom stopped nsg at 4 weeks and went to pumping exclusively getting
3 1/2 to 6 oz (total) each time.  Did so for 4 months.  This child around
again slow gain at 2 wk visit MD threatening suppliment gave mom 1 week to
increase inf wt.  At consult inf had gained 4.7 oz in 5 day still had 2
days to go til 1 wk up.  Test wt transferred  a little under 3 oz (sorry
specific measurements left at work) in 50min.  Fussy little thing.  After
feeding still rooting/hunger signs.  Worked on latch though had been well
over areola with audible swallowing.  After initial burst of suckling
slowed, added br compressions.  Mom prenatal vits, fenugreek 2 caps/day and
using a mother's milk tea, no hx of surgery or illness, denies anemia but
us unsure of recent bld counts.  Inf not on any meds.  Made wt goal with
suggestions able to attain more active nsg for the time at the breast but
inf still remained very fussy.  Ended up giving suppliment and baby took 5
oz consistantly after nsg and added 13 oz to her wt in no time per mom.
Mom pumping after nsg to stim supply and is getting 2 oz per br after nsg
15/15.
Look at latch again?  Do another test wt?  I can't help but feel that there
is still something not right about latch & milk transfer.  Mom states
resting, eating & sleeping well.  Getting frustrated and "It's happening
again...Is there something wrong with me?" is the question she posing to me.

 Baby 2-  3 month old boy.  Nsg every 2 hours, mom rented scale and is
doing her own test wts.  Inf getting 4 oz pretty consistantly pumping after
mom gets =<1/2oz.  Gaining well.  Here's the rub.  Fussy fussy fussy,
spitty spitty spitty.  Doesn't sleep well, very restless.  Mom had even
video taped night time sleeping for Pedi. They have a consult Tues.  Had
testing, no reflux seen at time of study but baby does projectile from time
to time.  Baby doesn't appear to really ever relax per mom.  In a 1 1/2
visit inf moved constantly herky-jerky is the term that comes to mind.
Stops wiggling for brief periods when focused on ceiling fan ... Doesn't
take bottle well either, very sloppy.  ? Silent reflux ? sensory
integration ?  Has had CST, and has seen Homeopathic MD all with no relief.
Baby has been extremely irritable since birth.  Pushed for 3 hrs then C-S
for no progress. Currently using Zantac with little or no change.  Mom
anxious RN, wants a fix.  Poor sleep for both so mom's getting very
frazzled using Xanax occasionally.
                                    ???
Your input would be greatly appreciated.TIA
Kathy Amell LVN
BF Specialist North Austin Medical Center
Austin, TX

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