Judy asks for input in a case of a slow-gaining, not thriving baby who has
calloused lips.  His mother has been sore from the start.  Judy describes
clearly and concisely a suckling pattern which sounds ineffective, rapid but
long jaw movements, and reports one pre- and post feed weight as one might
expect to see at about one week or less, not nearly a month, and hopefully
not after an hour at the breast.  Baby's current weight is less than 4
ounces over birthweight.  

Judy is most concerned about the suck, and I agree.  Everything she
observes, points to a baby who for some reason is not using his tongue,
cheeks and jaw in concerted effort, instead clamping with his jaws, with
resultant poor milk transfer and very sore nipples in mother.  He probably
had sucking blisters at the beginning but these have gone on so long that he
has gotten calluses.  I don't worry about small blisters if the baby is
happy and mother is not sore, but very often, blisters are a sign that there
is a subtle problem with the latch and it is well worth the mother's while
to be attentive about fixing whatever that is.  I've become more and more
convinced that mothers whose supply suddenly drops around two or three
months, are actually mothers who were at risk from the start due to
suboptimal latch, and the hormonal boost to breastfeeding in the early days
camouflages the problem, everything looks great, and everyone is mystified
when the milk nearly disappears within a couple of months.  This mother
probably never has produced as much milk as she could with effective
suckling.

This is a good example of when we need to go to the first rule, namely, feed
the baby!  This baby likely has some oral anatomy problems, or possibly some
tone problems that could be helped by physical therapy, but in addition he
may be tense and clamping even more because he is simply not getting enough
food.  A shield may be a good idea if it improves mother's comfort, but it
will not be enough to solve the food problem.   I wouldn't expect to see
what this baby is really capable of until he has gained half a pound, at
least.  If mother prefers to feed by bottle, I would really encourage her to
give the Haberman feeder a try.  If he isn't able to create a vacuum, he
will still be able to feed and it will allow her to offer an amount he can
handle, rather than using a regular feeding bottle which may actually worsen
his clamping tendency.  If the flow is too fast for him and he has a
disturbed suck, he might want to bite down to prevent choking.  All that
will do is give him even more negative feeding experiences, and neither he
nor his mother need that.

I might be tempted to suggest the mother breastfeed primarily as recreation
rather than as feeding for a few days, using a shield if that makes it more
comfortable for her, but if her nipples are really traumatized, she might
welcome the respite of simply pumping for a few days.  Finger feeding can be
really illuminating with a baby with an odd suck, and it can also be a very
effective way to get enough milk into the baby, plus it allows baby to have
physical contact without traumatizing mother's nipples further.

Judy's proposed plan of limiting time at the breast and pumping for set
times afterwards, and then supplementing, sounds pretty complicated, both in
terms of keeping track of times, and in terms of involving lots of work.
First breastfeeding, though not until baby has reached satiety, then
pumping, while we hope someone else can entertain baby or maybe feed him the
expressed milk from the last session, and then supplementing.  I would be
hesitant to use anything resembling force on this baby, even gentle pressure
on lower jaw.  He needs food and he needs it now.  Once he has gained a few
more ounces he may well relax and open wider anyway.  This very
comprehensive plan could also overwhelm a mother who to date has not
experienced enough of the pleasures of breastfeeding to know why this would
be worth it in the long run.  My hunch is her first priority is seeing to it
that the baby gets fed, and a very close second is making the nipple pain Go
Away.  Before trying another antimicrobial I would want to be pretty sure it
was microbes that were causing the problem, and I am not convinced of that
from the information given.

So, I would vote for simplifying the plan, based on two goals: getting baby
fed and protecting mother's supply.  I'd keep in touch with mother to make
sure her soreness is lessening and to adjust the plan as things improve.

Good luck, and do let us know how it goes!
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 email list is powered by LISTSERV (R).
There is only one LISTSERV. To learn more, visit:
http://www.lsoft.com/LISTSERV-powered.html