Could the baby have some sort of recessed chin or high palate, or any
other cause of insufficient transfer of milk? That would explain both
the sore nipples and poor weight gain.

I don't think the baby is nursing nearly enough, either. She really
should be nursing more like 10-12 times/day (I do know that several
places site 8-12, but anecdotally 8 seems to be on the very low end of
what works). And I agree that she should be awakened to nurse at least
once during that long stretch of nighttime sleep. However, that
wouldn't really explain the sore nipples. However, I suppose it is
conceivable that the older sibling's latch changed after birth, and
that could be a cause of the sore nipples. It seems less likely than
something about the baby's latch though.

And of course I always suspect a dairy sensitivity when I hear
spitting up, gas, and colicky behavior, but again, that doesn't
explain the sore nipples.

I'm sure these are all things you've thought of, but I just wanted to
"think out loud" with you. :)

Best,
Gina

-- 
Gina Gerboth
719-562-0262
719-369-4368 (cell)
~~~~~~~~~~~~~~~~~~~~
La Leche League of Colorado/Wyoming
Health Care Professional Seminar:
The Science Behind the Timeless Art
October 19-20, 2007

On 9/23/07, Pia Ruohotie <[log in to unmask]> wrote:
> Hello LactNetteers!
>
> I have had a puzzling case this week and I need help, please. I have mothers
> permission to post.
>
> Last monday a Mother called me and asked help. I havent seen her and her
> daughter, they live in another city quite far away. Then she sent me a
> qouple of SMS and email and i have emailed her back. Here is the story:
>
> Mother is 34 year old healthy, experienced nursing mother, normal pregnancy
> and delivery. So normal that they went home less than 24 hour after
> delivery. The Baby is now 1 month old and the main problem is weight gain
> and painful nursing (breast are sore and there seems to be some kind of
> wound also at least part time). The mother is tandemnursing 1y 4m old
> sibling who nurses twice a day. The Baby usually nurses first and the
> Brother after her.
>
> Nursing has been painful since the birth and the mother asked help from the
> pediatrician who checked the Baby before departure. The pediatrician said
> that there is no tongue-tie. The mother says that the Baby does not open her
> mouth wide and at the beginning the Baby sucked easily the lower lip with
> the breast. The Baby is also spitting up and has a lot of gas and is crying
> a couple of hours in the evenings. The Baby has some kind of rash. Mother
> said that she seems to have over-active MER at some nursings. The Baby has
> been treated for trush some time ago by home maid treatment (lingonberry).
> Baby nurses only 6 (-8) times per 24 hours.
>
> The weight gain is here:
> Birth 3510 g, height 50 cm (17.8.)
> Two weeks 3840 g (31.8.)
> 3,5 weeks 4180 g, 54 cm (12.9.)
> 1 month 4070 g (17.9.)
> (18.9.) Baby at the hospital 4065g, 54 cm
>
> The Baby was sent to the hospital for evaluation when the weight went down
> and was admitted. She was tested for pyloric stenosis and it was ruled out
> by ultrasound, no abdominal anomalies was found. The bloodwork was normal
> (infection, liver enzymes, electrolytes and NH3 values) so there seems not
> to be any metabolic disorders. They did test weigts and the Baby took up to
> 130 ml / nursing. No supplementation was not done or suggested!!! (They
> thought that the sibling maybe takes too much of the Babys milk which I dont
> suspect.)
>
> So it seems that we are back to the basics: latch (talked with the mother
> about getting more asymmethric latch), over-supply due to tandem nursing (I
> have talked with the mother about letting the Baby drink from the emptier
> breast also) and OAMER. I think the baby does not get the fattiest milk due
> the lacth and manadgement and due to discomfort does not nurse often enough.
> The Mother is going to see the bf support group leader at her home town to
> asses the latch further. I encouradged the Mother to nurse 1-2 times more /
> 24 hours but the Mother thinks that the Baby does not want to nurse more
> often. I hope she will consider still nursing more often. The Baby sleeps
> 6-8 hours without waking at night and I suggested that if the Mother wakes
> up on her own she could try to put the Baby to the breast.
>
> I am so frustrated since I know there is something wrong with the latch /
> babys sucking but I dont know any MDs at her hometown / in Finland to send
> her to. I know that many mothers have had help with tongue-ties in Finland,
> but if this is a more subtle one, there isnt anybody we could refer for
> sure. I encouradged the Mother to get a proper thursh medication, and as I
> was writing this I realised, that the Babys diaper rash and slowly healing
> nipples might be the trush complicating healing.
>
> Any other suggestions?
>
> Hopefully,
> Pia Ruohotie, RN, breastfeedign counsellor
> From Helsinki, Finland, Europe
>
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Denver, Colorado
www.lllcoloradowyoming.org

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