Introduction first:-
I'm Karen Meleng IBCLC (2000) in Perth, Western Australia. I have
recently begun private practice in partnership with two other LC's. I
have 10 years experience as a voluntary counsellor with Nursing Mothers'
Association of Australia (now known as Australian Breastfeeding
Association). Mother of three and many other roles.......

The case:-
I have permission from my client to share this situation with you.
Three week old baby. Induced labour at 38 weeks due to mother's
hyperemesis; mo reports 25 hrs labour followed by vacuum extraction,
pethedine, NO2
Baby has heart murmur and possible renal reflux (familial tendency)
Mo presented with concern that baby would not feed at the breast;
attachment difficult and fleeting; no seal; no drawing in of breast
tissue; baby becomes completely still after 4 "suckles" ; mother
expressing and feeding by Avent bottle, where baby exhibits similar
problems. Supplementing  with formula 60 to 200 mls per day. Mo
concerned that milk supply dropping.

Suck assessment (I hope I get the language right here). No rooting
reflex elicited. No gape elicited. Tongue held to roof of mouth
asymetrically. Light touch to palate did not elicit sucking reflex. Very
firm touch to junction of hard and soft palate produced weak sucking
motion x 4 then lips and jaw flaccid with tongue quivering in floor of
mouth.
When soft palate inadvertently touched no gag reflex but heaving motion
of baby's body.
Even the most gentle handling seemed to be overwhelming for this baby,
although she was calmed by quite vigorous rocking by her mother. In
other respects she displayed normal behaviours of a 3 to 5 week old
baby.

I counselled mo about more efficacious expressing techniques to help
boost/maintain supply and suggested she seek medical advice about the
baby's specific behaviours during feeding. She had previously reported
difficulties in attaching and keeping baby at the breast and had been
given quite plausible explanations that implied things would improve
soon. Mother sees no improvement at three weeks.

Baby is to be seen tomorrow by a Pediatric Nephrologist about renal
reflux. I suggested if this doctor unable to explain these feeding
behaviours mo should make appointment to see baby's other pediatrician
who was investigating the heart problem.
Please note that in Australia pediatricians are specialists and most
children are not referred to one. General family medicine is dealt with
by a local General Practitioner (doctor).

I would welcome input from anyone familiar with similar cases. It seems
serious to me as I work on the premise that not being able to feed is
almost like not being able to breathe.

Many thanks

Karen Meleng

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