Hi Ann Marie
Congrats on passing the exam, and it appears to me you are on the right
track with this baby, and will be an asset to our field! I do have a few
ideas.

Of course, I did think to try a nipple shield. There are a few different
ones, small and large size, so you might try a couple different ones. The
first thing I actually thought of with this baby was some sort of subtle
breathing problem. A baby who wants to eat, but it affects his breathing,
will not want to do it, but has to eventually, to get nourishment. I know
the baby has been checked out, but probably not observed by the doctors
during a feeding. Please do this. Also ask Mom about any subtle symptoms in
baby (becoming stuffy as feed progresses, any noisy breathing, or baby makes
little sounds even when not feeding, baby takes frequent breaks during
feeding, baby has increased respiratory rate after feeding, for example).

I also thought of baby wanting to self attach. Does mom exert too much
control over how baby latches? I have observed a few babies that don't like
a hand on back of neck and will latch better in cradle or side lying. You
might want to try that, or mom lying down supine and baby prone.

You said that baby did pretty well with you there, then reverted back to
fussiness at home. What do you think you did differently? Did you help mom
form her nipple first, use a "nipple sandwich" type maneuver? That often
helps if mom has somewhat short and/or soft nipples. What about reverse
pressure softening prior to latch? I find that helps evert the nipple and
get a letdown going.

I hope some of these suggestions will help. Please let us know how it turns
out if you can.
Laurie Wheeler RN MN IBCLC
Mississippi USA

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