I have a young dyad that is confounding me and would like to get some wise words of wisdom from your experience. It may be long-ish, but I will try to keep it as brief as possible. Permission to post.

Older first time mom. Scheduled c-section due to maternal PIH and low fluid at 37 weeks. Mom with history of hypertension and hypothyroid. Allergic to latex. Initially didn’t want to breastfeed, soon after birth changed her mind and has become the most determined to exclusively breastfeed mother I’ve met. (YAY!) Given a nipple shield in the hospital because baby had difficulty maintaining latch. She has done almost non-stop skin to skin since then. Tried to do some formula feeds once or twice a day at first and gave that up when baby because terribly irritable. Baby was diagnosed with reflux and started on Maalox, zantac, and levsin. Mom put herself on an elimination diet and it all helped some, but not a lot.

I first saw mother and baby at 6 weeks after she called and scheduled a consult to see about getting him off the nipple shield. Consult revealed the baby to have asymmetric, moderately receeded jaw. Tight neck muscles. Head preference for one side. I could still tell exactly how he had been positioned in-utero. His tongue moves very well. Mom has amazing supply despite all the difficulties and using the nipple shield every feeding. Even with the nipple shield, baby has a sucking click on one side, but not the other. Referred for body work, and clicking has been reduced to only about 50 percent of the feed on the one side. Still needs the shield for good latch, but he’s getting better. Head preference is much better. Neck muscles still tight – obviously needs more body work. Mom is feeding on demand, which is about every 1.5 hours during the day, and about every 3 hours during the night. He is gaining weight perfectly – about 40grams a day. He is now 10 weeks and still just seems to be miserable with his tummy. Pedi switched him off levsin & zantac and on to prilosec. Seemed to help a few days. About once a week, he will just get terribly cranky and fussy for about 48 hours. Arching and crying and wanting to constantly nurse, but then pulling off and arching and crying more. Stools will suddenly get green, and then change to brown. He stools about two or three times a day, good amounts. Usually yellow & seedy unless he’s having one of his spells. Mom and baby are on non-milk source adicophillus. Mom’s diet was very limited because she felt that anything she ate other than water, meat, and potatoes made him fussy and gassy. I got rid of the potatoes since she’s allergic to latex and had her add lettuce and other non-suspect cooked veggies from the farmers market since they aren’t likely to be ethylene treated.

This mother has been a champ and surprised even herself on how much she wants to exclusively breastfeed her baby. She is starting to get a lot of pressure from family (not dad by the way…another yay!) to try a hypoallergenic formula and see if his symptoms get better. Pedi has also suggested everything from pumping and adding rice cereal to the breastmilk, to 24 hours of pedialyte during his episodes, to half strength apple juice between feeds (?!?!) because “she’s feeding him too often” and that’s apparently why he has reflux and colic.   Mom has tried block feeding, switch feeding, biological nurturing...It all seems to help a few days and then he has one of his episodes, (So who knows if it really helps for a few days? Maybe he’ll have these episodes regardless?)  And to add to things, mom’s nipple are now “sensitive”. Not painful, just more sensitive. No signs of injury or infection or yeast. They look perfectly normal and they are sensitive all the time. They don’t look compressed or misshapen after feeds or blanched or irritated. Any suggestions on helping this mother and baby? Am I missing the forrest due to the trees?

Angela H. 
IBCLC, RLC

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