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Subject:
From:
Karen Seroussi <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 21 Sep 2003 14:48:27 -0400
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 Dear Wise  Lactnetters,
I would appreciate some opinions.  I have already searched the archives.
I also re-read info about tracheo- and laryngeomalacia.   I have
permission to post.
Primip with full-term 17 day old baby boy.  Natural birth-center birth,
normal pregnancy.  I saw them today for slow weight gain, reduced milk
supply.  He does a perfect impression of a nursing baby.  Mom has
achieved a gorgeous, deep asymmetric latch, with wide gaping mouth.
Baby cries with clear hunger cry, latches and sucks non-nutritively
(occasional swallows) until falling asleep within 30 seconds.  When
removed to rouse, repeats same.  He has been eating just enough to
maintain his weight. 
When he starts crying before nursing or when removed from the breast to
rouse, he begins a cough with a slight barking tone.  Not like croup but
not a normal cough either.  It is repeated about 5-8 times before he
stops and calms to latch.  There is no sound when he breathes, on or off
breast.
Initiated supplement at breast and alternate massage/compression to
observe his ability to suck-swallow-breathe because I was wondering if
he was avoiding milk flow to protect his airway.  
At first, when he was surprised by the milk in his mouth, he gasped a
few times.  But, after continued intermittent and slow supplement, he
was able to suck-swallow-breathe with what looked like a fairly normal
rhythm and no apparent distress.  After getting the hang of it, the
baby’s suction drained the dropper we were using and his jaw excursions
improved significantly.
So, to those of you with more knowledge about throat/muscle pathologies,
is a barky cough without stridor (or any congestion I could hear) in
combination with poor milk transfer a cause for immediate diagnostic
exploration or watchful waiting?  
This baby is under the care of a breastfeeding-friendly Ped. and we have
implemented supplements and pumping, but I have a niggling worry with
this little guy and would like to get as much info as possible.
Thanks for all info and insight,
Karen Seroussi, BS, IBCLC
South Florida, USA
 

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