Allyson,
It sounds as if this baby is not comfortable with feeding. I would
definitely rule out tongue-tie, especially since her first baby had issues and
there is a genetic link with TT. Not questioning your ability to diagnose,
but you said you did a suck assessment and didn't mention going under the
tongue to elevate it and this can reveal those sneaky ties. If there is no
tie, I'd consider possible birth trauma and assess infant's structure and
ability to use both sides of his body equally, especially upper body and head
and neck. Rule out difficulty here, and then consider mother's diet and
possible sensitivities in baby.
Swallows normally are not associated with squeaking nor should swallowing
be gulping nor noisy. This can indicate difficulty handling a bolus or
malacia. The thrush is often associated with tongue-tie or
sensitivities/allergies. Sounds to me that baby is nursing to eat but due to his discomfort
with the process won't stay at breast for leisurely feeding or comfort. Of
course this type of feeding contributes to infant and mother stress and
down regulation of supply over time. Would also consider mother and baby
probiotics.
Hope this is helpful and that once the cause for feeding difficulty is
found and addressed, mother and baby can enjoy breastfeeding.
Barbara Latterner, BSN, RN, IBCLC
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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