Hi:
Any tips for slowing down MER without lowering milk production?
I have permission to post: And this is sorta long and i thank you for your
patience.
Mom came to me with first baby - tongue tie - resolved issue and continued
with happy breastfeeding relationship.
Second baby - painful traumatized nipples and oversupply, with baby gaining
at the rate of 3 ounces per day.
Fairly easy and quick turnaround for her and within 1 week issue resolved and
again continued with happy breastfeeding relationship.
Third baby - consult at 3 weeks of age. Given a nipple shield in hospital for
flat nipples ( which appear everted to me now), blood incompatability and little
interest in breastfeeding first 3 days and baby went from 8# 4 oz to 7# 6 oz.
4th day major interest and 5th day is 7# 9 oz.
Two week visit baby is 8# 11 oz. Still using nipple shield. Mom has tried
without it but says baby refuses. Observing increasing fussiness and problems
with breastfeeding with regards to milk flow and mulitple let downs. Feeds are
always from one breast and baby done in less than 10 minutes. Mom says it is
very unusual for baby to last more than 10 mnutes.
Three weeks: calls with complaints of projectile vomiting at least 3 - 4 times
a day and lots of spitting up after every single feed. Baby becoming
increasingly upset by milk flow at breast and even more upset with vomiting -
beginning to cry so hard he turns red and she has to work hard to calm him
down. Then he is done with feed, but when it is interrupted in the first
several minutes he wants to feed again very quickly. process happens all over
again.
See mom 2 days after initial phone contact. She has tried positional changes
and finds laying on her back helps somewhat and sometimes. Poop is now
green, baby is now crying lots during feeds, squirming on and off breast with
let-down, shield is always filled with milk when baby comes off. Oh, and baby
weighs 10# which is approx. weight gain of 3 oz per day this past week.
Work with mom and baby without shield and baby is adamant about not taking
breast when encouraged by LC to just gently hold baby near breast. Baby
thrashes head back and forth, will lunge forward toward breast, but not
finding what he wants, cries and kicks. Tried gently bringing baby toward
breast, tried bringing breast to baby. Tried hanging from chandelier... JK!!
So, worked with mom with nipple shield, being sure baby opens nice and wide
and achieves deep latch as this will help when weaning from shield.
After practicing for about 10 - 15 minutes, baby begins feeding and in 8 m
inutes flat he is done and intake shows a whopping 5 oz. In this 8 minutes,
he came off twice, coughing each time ( BTW - mom would say - here it
comes - another let-down - 3 in 8 minutes!) Spit up was actually quite
minimal.
Care plan:
Set aside weaning from the shield until milk production is lowered.
Practice same side feeds (x3), paying close attention to baby's cues.
If baby happy with 3, continue until baby cues that it is not "good enough"
Decrease the 2 and then one breast per feed.
Mom knows it may take several days or more. Mom knows to keep in close
touch with me as she observes changes and we can discuss them. Mom
knows that while she has major milk production, she is still using the nipple
shield and we always need to be concerned about lowering too much.
Mom will take good notes on observations of frequency of feeds, which side,
how many times, output changes, baby's feeding behavior and changes in
times of projectile vomiting and spitting up.
Within 2 days, she got down to 2 feeds on one side and 4 days later is now
down to one breast per feeding. Baby is about 50% more settled during
feedings, projectile vomiting is gone and spitting up is of what she would
consider normal amounts after some feedings.
Mom feels her production is still excellent as she pumped on Monday to go to
Pumpkin Farm and in 10 minutes expressed 5 ounces on the side baby would
go to next.
Problem:
MER is still multiple times during a short feeding and so forceful that baby cries
sooo hard from it and mom is becoming weary of the time it takes to calm him
down and weary of watching him be so upset and appearing to be in pain.
Baby spit up blood last night. NO cracks in nipple. Could be from irritation
from spitting up so much.
My suggestion to her:
Empathize
Patience
Write down what your complaints were 4 days ago and write down what has
changed and to what percent they have become better.
Mom writes back:
Complaints about projectile vomiting gone. Complaints about upset baby
reduced about 50%. Nice yellow stools and gone are the green frothy stools.
Most of the time sleeping better, but times of inconsolability after several
feeds still and during some feeds.
My suggestion:
Check up by doc with peds. Remind mom that she will want to carefully
consider any suggestions doc makes particularly regarding further testing,
reflux meds, etc. ( My words to this group - not to mom - So, would like her
to get baby checked out so a doc has eye on baby, but it opens the door for
possible improper intervention - need to balance this. )
So, my questions are:
Any additional suggestions? I am not wanting to lower her production much
more as she is still using the nipple shield. She only pumped that one time in 4
days. I feel her major problem at this point is such a forceful MER that pains
baby. I would like to hear various theories as to why this happens. Also
would like help in reducing or calming down these MERS? No weight check
since initial consult 4 days ago.
Thanks so much for any suggestion you can share.
Lori J. Isenstadt, IBCLC
Peoria, AZ
www.aabreastfeeding.com
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