I'm puzzled about how a baby I saw day before yesterday is acting.  She is two
days shy of four weeks old;  birth weight of 7' 15' down to 7 lb. 11 oz. on
Day four.  At two week check she was just shy of 9 lbs.  The mother contacted
me because two weeks ago her daughter started getting fussy and wouldn't latch
on after coming off the breast prematurely during the feeding.   The mother
reports that since then the baby has fed better  - longer - during the night
and right after waking up from napping but otherwise not well in the day time.
No ankyloglossia, normal palate.  No thrush.

My observations: when baby first wakes up and shows signs of wanting to suck
she makes a few initial rooting attempts to get onto the breast, makes it by
the third try and gets a good suck/swallow rhythm going, gulping strongly,
which lasts for a few minutes.  Then the baby comes off the breast.  It
appears that the mother's let-down is quick, that she has her let-down when
the baby gets the latch.  It does not look like she comes off because she
cannot handle the flow; she is not sputtering, choking.   She then hunts
around near the breast the same way as initial latch-on but will then not
latch-on and gets fussy.  She grunts, she makes unpleasant, unhappy sounds,
she sounds angry.  She cries a bit.  She is not crying steadily and she is not
pulling up her knees.  Keeping her upright, doing 'the baby dance', shifting
to the colic hold really do not change this fussiness.  She did burp, calm a
few minutes, then fuss some more.  She will take a pacifer, suck and be
calmer.   While I was there she fell asleep with the pacifier (it fell out of
her mouth when she fell asleep) and she slept for a short while and when she
awoke she latched on fine and nursed, again, for only a short while, came off
and would not relatch.

 We talked about using this pattern right now in a positive fashion -
expecting to breastfeed when she awakens and NOT offering the breast right
away after she comes off - to see if that behavior would die out.  It did
appear that the baby was frustrated and angry when she wasn't latching-on.
She does sometimes just stop rooting then and go 'on strike', seeming to be
asleep but if you lift her eyelid she is looking right back at you.   I did
see some need in improving positioning & latch-on.  The mother was bringing
the baby's head to the breast, flexing it by holding the head up behind the
crown; we worked on bringing the whole baby in and on having the lower lip
further away from the nipple.

The mother does not usually use both breasts at a feeding.  The stools are
normal bfg stools, except when the mother called me she said one stool that
day had looked flaky, adequate urination.  They had not been using a pacifier
until they were at their wit's end one recent night and bought one.  All this
behavior happened without any pacifier use.  While I was holding her after her
refusal of the breast I noticed she does a lot with her tongue.  She keeps the
tip up against her palate behind her upper alveolar ridge some of the time,
she protrudes it, she pulls it back in, thickening it.  I wondered if she was
accustomed to having it up and tries to change her tongue position when the
MER slows, loses her grasp, and then doesn't like it that the milk isn't
streaming into her mouth.   The mother started eliminating dairy before she
called me.   She was using some cream cheese on a bagel for breaskfast or milk
in cereal, an occasional yoghurt. Not a lot of cheese.  Bland diet.

Any thoughts?  thanks,
Mardrey Swenson, DC, IBCLC
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