Dear All
I've been following the history of the baby who will only feed while
sleeping, looking for clues!
I am currently working with a seven-week-old baby who seems to be very slow
to learn to breastfeed. This little boy was referred to me at 15 days by
the paediatrician for weight loss. He was born at 39 weeks, normal
delivery, no complications, no suctioning, weighing 3000g. He was
discharged fully "breastfed" at 3 days. By 9 days he had become dehydrated
(now 2750g) and jaundiced, TSB nearly 400, and was readmitted to hospital
for phototherapy, IV fluids followed by formula, and discharged 2 days
later. By 15 days I became involved because he still wasn't breastfeeding
properly.
A BF exam confirmed that mom's nipples were an "easy" shape and size, but
baby's chin receded slightly more than usual, he sucked in his lower lip and
slurped on to the breast, seeming reluctant to take a wide gape, and mostly
tongue-sucked. As you would expect, there was minimal/no milk transfer and
mom's breastmilk supply had been severely compromised. A nipple shield did
not seem to "work" for this baby either.
I suggested what I usually do for low-supply situations - attempt
breastfeed, top up with EBM, then formula, provided manual pump etc. I also
suggested bottle-feeding this little one using an ordinary rounded teat, to
"teach" the tongue to come down and forward. Mom was wildly successful
within a short time in returning to exclusive breastmilk-feeding. The baby
was quite difficult to bottle-feed too, being reluctant to open his mouth
too wide, but is now doing fine, aged 7 weeks, and his average daily gain
since I saw him at 15 days has been a massive 48g/day (1.5 oz).
We had a follow-up yesterday to try and get *breastfeeding* itself
fine-tuned. The baby's chin has come forward, his tongue stays down, his
palate seems to have flattened out a little, his paediatrician has examined
his mouth, throat, nose and ears and nothing is wrong, mom has a great milk
supply, all the right things. Yet this little guy remains almost impossible
to *breastfeed*. He will now latch, still slurps on to the breast,
reluctant to open the mouth, but then flutters happily and falls asleep!
Breast compression stimulates the let-down, but still he will not suck!!
Mom still maintains there was no suctioning at birth. He is still sometimes
difficult to bottle-feed too, but obviously she manages it, as evidenced by
the fact that he is really thriving. Her latching technique is very good,
it's difficult to get this little guy to latch deeply on to the breast, but
she does achieve it, and she is sensitive to his tolerance levels, stopping
if he becomes upset. We spent an hour and a half together yesterday so I
was able to observe all this.
So now, I'm stumped. In similar cases, the baby seems to breastfeed really
well after 2 - 3 weeks once you get the positioning and latching techniques
co-ordinated. This one is going on too long. He seems bright, normal,
active, thriving, in every way, but he just wont breastfeed! Does anyone
have any suggestions? Barbara, I wish I could refer this baby to you!! In
the meantime I have suggested that mom continue what she is doing, with the
exception of setting aside 4 - 6 hour periods in the afternoons (when the
baby is more active) where only the breast is offered, to provide more
practice. However, because I still saw very little milk transfer at the
breast, I've suggested continuing to pump and bottle-feed the EBM after
breastfeeding attempts at other times unles mom is aware of good swallowing.
I still don't think attempting to go cold turkey with this baby would work
and still think that his nutrition needs to be protected.
Sorry so long. Any thoughts welcome.
Pamela Morrison IBCLC, Zimbabwe
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