Permission to post: Mother (g1p1) in to to visit because infant has been increasingly fussy over the week. Mother felt that breastfeeding had not started off well and that infant did not have a good latch. Infant now 6 weeks old. 3 weeks ago they had both been treated for thrush. It was this last week after treatment stopped that infant had been fussy. She also has seen infant spit up more. She has pumped occasionally. Once in the evening she obtained 3 oz. Once in the morning after  a feeding, she pumped for only 5 minutes and obtained a total of 3 oz. She stopped after 5 minutes because the spray stopped. 


Mother breastfed her 1st child but stopped due to what she thought was low supply. Infant started to have slow weight gain and long story short her peds told her to go to formula. She was a victim of poor advise and common misperceptions.  She was not successful with pumping to keep supply up with 1st. She has since switched peds.


Infant's birth weight was 8#7oz and at 3 weeks was 9# 13oz. The visit with me @ 6 weeks was 11#1oz, which I calculated was slightly smaller than 1 oz a day and certainly slower than the 1st 3 weeks.


Suck and palate assessment all normal. No TT noted.


At breast, infant fed calmly for 5 minutes before pulling off. Mother had been noting infant doing this more and more, fussing after several minutes but would return to breast for a couple of more minutes. She felt that infant would have a squeaking sound with feeding. Infant would not return to breast after the 5 -7 minutes but would just fuss at mother. I perceived the squeaks to be swallows. Infant did not look to be in distress and seemed to handle the feeding easily. However, infant did have a good crying spell for over 10 minutes in my office before calming. She did return to breast a couple of minutes each side more.


Mother has only used cross cradle so we tried straddle hold and I did not hear many swallows. Once returned to cross cradle, at other breast, infant had loud swallows again. Over the course of the feeding, infant took 3.2 oz. He did have some spit up but not large. 


I am working on the theory that this child had gotten used to mother's possible strong MER, hence the perceived poor latch and big weight gain in the 1st 3 weeks. Now infant is fussy when MER is slower.  I wondered about possible sore throat r/t thrush?


Mother asked about herbs, such as fenugreek but I am not sure that is the way to go.


What jumps out at anyone else?


TIA,


Allyson Michaels, RN, IBCLC
Charlottesville, VA


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