In a message dated 3/8/2004 9:35:45 AM Eastern Standard Time, [log in to unmask] writes:

> A 37 weeker, now almost 2 weeks old and well below birth weight.  She didn't
> latch well from the beginning...
> Baby started to get jaundiced, was under
> lights, and the hospital nurses started her fingerfeeding with an S&S and a
> nipple shield...
>  Yesterday
> infant was 8 ounces under birth weight, transferred about a half an ounce
> with the nipple shield.  She nurses briefly on the nipple shield, swallows
> what is in the tip and waits.  Mom is basically hand expressing into the
> shield and baby swallows.  She does well with finger feeding, but family is
> frustrated...
> So I had brought a bottle, the evenflo ultra nipple and we
> tried that.  This infant can't latch well on this either, was quite confused
> and tried to work the tip, milk rolling out of her mouth. With some work,
> mom and baby finally got this to work a bit well, but still loose at the
> corner of her mouth.


Pat, since I work mainly with mothers having multiples, the baby you describe sounds like most of them when born close to term. Their ability to feed often is not quite there; they often are pretty good latchers but not good sustainers -- they have not quite got it together re: fine-tuning suckling. Based on this infant's response to bottle-feeding, ineffective BF may be more of the messenger (being shot at) for the more general "infant feeding difficulty." (A question re: finger-feeding -- has this baby had to suck on own to transfer milk to get food via the tube or has baby received a bolus via the tube to swallow and repeat?) Not getting enough calories to grow is likely adding to the problem.


> Family has been playing with infant to open mouth and stick out tongue with
> limited success, partially because of their huge extended family who is
> there almost every moment the infant is awake and want to hold her.

This strategy may work better once baby starts getting enough nutrition/calories. Getting enough food is also likely to help baby get her act together to coordinate suckling. (Can this mother "lose" some of the extended family who seem to be creating more stress than they are alleviating?)


> I sent mom back to the pump since her supply initially huge has dropped back
> to normal, can always pump 2 ounces, used to get 4.

I don't understand why this mother would ever have stopped using the pump since baby has demo'd ineffective breastfeeding from the get-go. When a baby can't remove milk effectively, production is bound to drop if something else isn't doing the job as per my BF rule #2 re: move the milk. I find moms tend to feel more encouraged, even when baby doesn't yet have breastfeeding together, when production is adequate.

Other thoughts re: your observations of suckling pattern may be to keep outside help, such as cranio-sacral therapy, a neonatal OT, etc. as possibilities IF calories and a couple more weeks don't do the job for this baby.


> I am encouraged much skin to skin and cobathing, all hard with the baby
> party going on.  Mom really wants this to work but is
> getting exhausted and
> discouraged.  Anyone have any other thoughts about this.


Ask the mother what she needs to do or NOT do in order to hang in. When something's got to give, strategies that will help her achieve her long-term goal by modifying short-term goals, e.g. how long do breastfeedings last can be more worthwhile. (I'd rather compromise a plan and see baby at breast long term vs. have an overwhelmed mother throw up her hands and quit.) Since baby has consistently demo'd ineffective breastfeeding, limit some/all BF to 10-20 minutes "practice breastfeeds" to more allow time for pumping and kangaroo care. Suggest she enlist family to implement some/all alternative feedings so mom's sanity remains intact -- often a relative can be handling an alternative feeding while mom pumps. However, it is crucial that those handling alternative feedings be instructed on how to give them without adding more roadblocks and compromising long-term BF goals.

Go over the revised plan and ask the mom if it is something she can live with for at least 3 days. If it isn't, revise some more. When a mom doesn't feel "consumed" by breastfeeding, pumping and alternative feeding, she usually gets a little sleep to help with the exhaustion and loses the feeling that breastfeeding is too ding-dang hard to continue.

You may be able to help this mother with perspective. The fact that her baby can latch on and suckle somewhat means the baby has the basic idea; that is something to celebrate. Her baby is only 2 weeks old (39 weeks gestation) and baby is likely to do better as she gets more calories and CNS matures a bit more. She and her baby WILL get there, as the MOTs/MOMs I work with can attest to with multiple newborns, but they need a BF care plan that relieves some of the exhaustion and helps the mom feel her sanity isn't going.

You may want to check the archives for the recent discussions re: not quite term babies needing more time than reaching 40 weeks for BF to come together, Dee Kassing's article re: bottle-feeding technique that reinforces BF, etc., although for now that may not yet achieve rule # 1 re: feed the baby.

I hope this is somewhat helpful...

Karen
www.karengromada.com/

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