Sure sounds like reflux.  The oral cavity should definitely be assessed but
you described some of the classic symptoms I am seeing, and I've been seeing
a LOT of reflux lately (still wondering if deep suctioning at birth has any
connection???)  These babies want to suck, but they have a hard time
handling milk going down (and coming back up periodically) so they get very
fidgety and even downright angry when the milk lets down, which is what this
baby seems to be doing.  They also get fussy after the feeding is over (when
I'm guessing the milk is refluxing and seem to indicate hunger (sucking
being a comfort measure) by wanting to suck, so mom feeds them again, and
they get fussy again and it's just a vicious circle.  You can see the entire
spectrum, from babies not wanting to eat much, because of the discomfort to
babies who seem to want to nurse all the time.  I tell parents of babies
like the latter that these cues are somewhat unreliable because the baby
isn't really hungry, just in need of comfort.  These babies usually tend to
be good gainers, so you know they're getting plenty of milk.  The other
babies seem to drag along on the weight scale.  Funny how the same problem
can cause such opposite reactions!  Positioning baby more upright seems to
help and limitng feeds to one side only can really help.  If baby gets fussy
after feeding, put them back on the same breast.  I even tell moms to use a
pacifier and swaddling for some babies, as this seems to be the only way of
breaking the cycle and calming them (these are not the slow gainer babies,
obviously!)  Another strategy is pumping off some milk first so that there
isn't a deluge of milk at let down, and what they do get is higher in fat.
I have one mom I've been working with for almost 3 months and it took us a
long time to get this baby exclusively breastfeeding.  She refluxes BAD but
the doc didn't want to prescribe meds.  Baby showed some aversive behaviors
for awhile, but mom kept working on it and she ended up loving
breastfeeding.  Oh, I also see biting/clenching behaviors during feeds with
these babies as they try to deal with the flow of milk and their own
problems with reflux during the feed.  

I believe a lot of breastfeeding problems are due to a failure of the baby
to trust the breast.  If he's had the bottle first or a lot, or mom's supply
is low, or he's dealing with something like reflux, then feeding isn't
satisfying to him/her.  You have to prove to him/her that he/she can trust
that they will get fed and it will be a pleasant experience.  This requires
different strategies for different babies, sometimes calling for a shield, a
bottle or even a pacifier!
Hope some of this helps.  Good luck to this mom.
Marsha  

~~~~~~~~~~~~~~~~~Marsha Glass RN, BSN, IBCLC~~~~~~~~~~~~~~~~~~~~~
Mothers have as powerful an influence over the welfare of future generations
as all other earthly causes combined.
~~~~~~~~~~~~~~~~~~~~~~~~~John S. C. Abbot~~~~~~~~~~~~~~~~~~~~~~~~~

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