Hello fellow Lactnetters;
This situation has me puzzled and MAD !
Any suggestions or comments are greatly appreciated to get this baby back to
the breast !
[Thanks in Advance !]
This mother contacted my office on April 30th, 2000 regarding her
breastfeeding difficulties and concerns. She felt that her 5 week old son
was not nursing well again( was clenching/ gumming before---easily remedied
with improved positioning and latch-on). This time he had been spitting
and/or vomiting 2-3 times, moderate to large amounts of fresh/curdled after
every feeding for the past week, and her nipples were becoming very painful
(burning sensation) after every feeding (sometimes up to one hour PC). The
baby has also been grunting during each of his feedings, and sometimes in
between, and he seems more fussy now despite his frequent feeds (hourly at
times). He has been voiding and stooling in sufficient/frequent amounts. His
mother has also mentioned her concern that the baby has "what sounds like
very active bowel sounds" in between feedings and passing lots of flatus
rectally. A slight diaper rash was also noted in the past week, not
responding to "IWK Hospital Paste".
The mother has also informed me that she had seen her doctor by office
appointment on Friday April 28th, 2000, and that he had shown a good weight
gain since his last doctor's visit (approximately a month ago).
My impression of this current situation is possibly due to:
1. an increased milk ejection reflex due an overabundance of milk supply
directly related to Andrew's frequent feedings and/or mom's normal milk
production resulting in spitting/vomiting episodes. Andrew may be receiving
increased foremilk and decreased hind milk resulting in a faster emptying of
his stomach and increased hunger/fussiness [ we worked on decreasing this]
2.Thrush infection on mother's nipples that has been transferred to baby's
oral cavity and passed on down through his gastrointestinal tract; resulting
in fermentation inside the bowel and increased bowel sounds, fussiness, ?
vomiting; slight rash starting on diaper area [we discussed possible
treatment options]
3.Because the baby was 37 weeks gestation at birth, and is approximately 2
weeks old corrected age now, he may fit into the time frame where "Pyloric
Stenosis" may be a concern----although mom does not state that her baby has
been vomiting projectilely or with any great force this past week.[I advised
her to see her doctor again, and sent another detailed report]
On May 1st, this baby was admitted to hospital to speed-up investigations to
rule out Pyloric Stenosis and Gastroesophagel Reflux by ultrasound and Upper
GI swallow with pedialyte (vomited this also) Tests proved negative for both
according to the mother. Following her one day stay at the hospital, mom and
baby returned home and continued to breastfeed and the baby continued to
vomit---both getting more upset with this situation. Throughout all of this
time , this baby has continued to grow at an acceptable weight gain ( 5-7
oz. week approx.), and has had adequate stooling and voiding.
The baby's Pediatrician recommended first that mom limit feeds to 5 min.
( but he just was too hungry, wanting to eat every 45 minutes, so was
supplemented with breastmilk by AVENT bottle system and continued to vomit).
Then he wanted the mom stop breastfeeding and try a soy formula to see if he
could stop the vomiting. Since Friday ( May 5th) this baby has taken 3 to 4
oz. by AVENT bottle system per feed and retained all (no further vomiting !)
Mom continues to pump and save her milk---wondering for what... I suggested
that she might try mixing 1 part breast milk to 3 parts soy formula, and if
he tolerated that, then to perhaps gradually increase as tolerated the
amount of breastmilk and decrease the amount of formula per feeding. And to
seek baby's doctor's approval or at least discuss what she was trying. She
really wants to breastfeed this baby, but is really discouraged now that the
baby is retaining the soy formula. [This is her 2nd baby, she nursed her
first for about 5 months.] Abdomen (baby's) continues to be distended at
times, grunting in beteen feeds while sleeping is decreased.
ANY SUGGESTIONS, AS THIS ONE HAS ME PUZZLED AND MAD !
Thanks for your help as always,
Barbara Montague RN IBCLC
[ Private Practice ]
Saint John, NB CANADA
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