This will be my first time posting, so bare with me. After reading your post, I
just had a few questions and ideas:
“Originally seen for sore nipples - helped with latch, things are better. Then
at day 7 baby could not cope with milk supply; fussy at breast, pulling off,
green, frothy stools. Worked with this, baby fed better, stayed on the
breast, stools became normal looking. Seen at day 17 for staying on the
breast two hours at a time. Baby only eating every 6 hours. Weight loss of 3
oz.”
- Did mom appear to have a forceful letdown that the baby couldn’t
handle AND did you see any signs of nipple compression to compensate for
this?- This was my first thought after reading your post. This would account
for the sore nipples and potentially the weight loss/stall. Have you done pre
and post weights to determine milk transfer? If so, how much is the baby
transferring and how many stools is she/he having?
“If baby comes off mom has milk everywhere. (Also, mom able to pump 8-
10oz with manual pump).”
This honestly sounds to me like an oversupply/forceful let down
situation. I would bet that the baby is clamping down and is not transferring
any milk. It is probably also why baby is shutting down and not showing any
interest in the breast, because he/she is seeing it as a negative experience
when going to the breast.
"At home baby only willing to take 1oz of AIM. "
- Is this the first time baby has been introduced to a bottle?
I have followed several moms with forceful let down and have even nursed my
own children through it. I found positioning to be the key, with side lying or
reclining to help the infant to compensate better. The nipple compression
typically resolved once milk flow and production regulated between 6-8
weeks; with only one baby retaining the habit to 4 months.
I also like Ms. Wheeler’s suggestion of having her pump and supplement with
EBM for 24-48 hours rather than AIM, especially when mom can produce so
much milk, to see what sort of weight gain you get with measurable input.
Some pediatricians are quick to jump to the “easy way” especially if they only
have 10 minutes or less with their patients and don’t have enough time to help
trouble shoot the situation with the patients instead.
Shannon Theiss, RN, BSN
Pediatric Nurse (LC-in-training)
Hello everyone,
I have permission to post. I have been working with a mom and baby, now 19
days old. Birth weight 7lbs 3oz. Day 3 7lbs even. Day 17 7lbs, Day 18 6lbs
14oz. Originally seen for sore nipples - helped with latch, things are better.
Then at day 7 baby could not cope with milk supply; fussy at breast, pulling
off, green, frothy stools. Worked with this, baby fed better, stayed on the
breast, stools became normal looking. Seen at day 17 for staying on the
breast two hours at a time. Baby only eating every 6 hours. Weight loss of 3
oz. Mom trying to wake baby, but not much success. Went over latch,
positioning. During observed feed baby is actively sucking at breast with good
milk transfer. If baby comes off mom has milk everywhere. (Also, mom able
to pump 8-10oz with manual pump). Mom went home to shorten time at
breast and get baby latched every few hours. Called next day for sore nipples
as baby won't latch well during the times she wants to sleep. Seen on Day
18. Weight now 6lbs 14oz. Baby chewing at breast. With some adjustments
baby sucking much better. Long feed about 1hour 15 minutes, weight 7lbs.
Pediatrician wants mom to give 2oz AIM after every feed (specifically told not
to use ebm) and to see mom on Day 25. At home baby only willing to take
1oz of AIM. Parents very concerned. Oral exam of mouth showing nothing
unusual, baby exhibits good suck. I am seeing mom today, but am not sure
what is going on. Any ideas?
Thanks in advance.
Adrienne Guirguis, IBCLC
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