I have mother's permission to post to ask for suggestions. Baby is 2 months old and has never seemed to relax and enjoy feeding. According to mother she chokes, and 'gasps for breath' during feeds. She also spits up more than mother feels is normal. Mother had been very sore earlier but is better now, after first trying silicone nipple shields and then going over to pumping and feeding by bottle for the past few weeks. Mother's soreness was exacerbated by shields, but baby seemed less stressed when they were used. Still, the pain led to mother deciding to pump instead. Weight gain has been excellent though has fallen off a bit since bottle feeding of EBM began. Baby is active, alert, and cheerful otherwise but doesn't have a pleasant time breastfeeding. She contacted me nearly a week ago, because she is unsatisfied with pumping and bottle feeding, and baby was not enjoying attempts to get her back to the breast. I observed a feed the next day, and could not see anything obviously wrong with latch visually, but there was a clicking sound with suckling and mother felt discomfort when it was heard. Baby was wiggly at the breast, squirming as if trying to find a better position, though very willing to latch repeatedly. We tried maximizing extension of the neck and using an exaggeratedly asymmetric latch, which made little difference in baby's behavior. Her oral cavity looks normal to me, and there is full tongue mobility. When the MER occurred, baby let go of the breast and just waited. When she is on the breast, milk frequently runs out of her nose. This also happens with bottles, according to mother. At that point the baby will cry and choke. She also makes snorting noises like a little piglet when she is hungry. It looked to me like a combination of a few problems: overactive MER, likely overproduction as well, and possibly a suck/swallow/breathing difficulty, perhaps some kind of obstruction or laryngomalacia in baby. Overlaid on this was that baby was now accustomed to the flow and technique of a bottle. I suggested several things. 1) one-sided feeding for 3 hours at a stretch to reduce overproduction 2) manual stimulation of MER, and waiting for it to subside before offering baby breast 3) BFing positions with baby higher than breast 4) using finger feeding rather than bottles if baby doesn't stay on breast long enough to soften it, or to satisfy her hunger. After some days of doing this, mother reports baby seems to be less restless and fussy since she started one-sided feeds. Baby tolerates finger-feeding better than any other method to date and is taking about twice as much milk as she did from bottles, but mother would love to have her back at the breast. When she offers, it is just as stressful as it always has been, and baby takes ages to feed, because she 'just latches and then doesn't DO anything'. Mother can feel that baby is using her tongue actively and seemingly correctly while finger-feeding, but at the breast it seems she doesn't do so. Mother also reports, somewhat ashamedly, that baby uses a pacifier, though only after mother is convinced that baby doesn't want milk and won't settle by any other method. I must be missing something here, I feel. All suggestions welcome. Please cc me privately when you post to the list so I can find the responses without sifting through digests. Rachel Myr Kristiansand, Norway *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html