Dear Mandy,



I agree with what has be already said about possibility of fullness of breast due to lact 2. I would also just add in to check for structural oral restrictions such as tongue tie(Ankyloglossia) ect. A baby will with varying degree of tongue tie may be happy to be breast when milk supply is manageable in the first 3 days however finds it hard to manage a deep latch while coordinating sucking, swallowing and breathing with a robust milk supply often regressing in a breast refusal kind of behavior. 



Hope that helps.



Yasmin

MA, HDSE, LLLL, CLEC, IBCLC

Mumbai, India

Sent on my BlackBerry® from Vodafone



-----Original Message-----

From:         Mandy Ball <[log in to unmask]>

Sender:       Lactation Information and Discussion <[log in to unmask]>

Date:         Sat, 23 Feb 2013 19:23:12 

To: <[log in to unmask]>

Reply-To:     Lactation Information and Discussion <[log in to unmask]>

Subject: Breast refusal in the first week



Hello all! I just saw a mother of a 5 day old (39weeker) who breastfed well until day 3 and now refuses to latch and nurse. Se will take expressed milk from a bottle. She was 8.1 at birth and was 7.7 yesterday. I suggested waking her at the 2-2.5 hour mark to nurse. She has been letting her sleep 3-3.5 hours. I also suggested lots of skin to skin between feeds to encourage her to latch on her own. When put to the breast she opens wide and will not suck, but just cries. Mom has tried different positions and nothing seems to be working. We gave a small amount of breast milk via bottle (i know not ideal, but that was what mom wanted) and the baby then latched with a nipple shield for about 5 minutes. But when we removed the shield she cried again and would not latch.  I am hoping that feeding her early, before she is so hungry, will help. But I wanted to see if there was any other suggestions from you guys. She has a very strong suck and mom has a great supply. 

Thank for your help and suggestions. 



Mandy Ball, RN IBCLC



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