I'd really appreciate input on this case, about what I should be looking
more closely at.  I have some ideas about what it might be but I don't want
to prejudice anyone by broadcasting them, and I really don't want to jump to
hasty conclusions.  I figure there is less chance of doing that if I ask for
comments.  Please cc me as well as sending your reply to the list, as it
will make it simpler for me to find the responses tomorrow from work.

I'm seeing a mother of a two month old baby who has been gaining fine but
very unhappy with feeding.  Mother contacted me because breastfeeding is so
stressful.  Some feeds go smoothly, most often at night.  Other times, he
seems hungry to mother, will latch on and suckle for about five minutes,
after which time he pulls off, though continues to behave as if hungry -
hands to mouth, rooting a bit.  Mother notes that milk is often spraying
from her breast when he lets go.  If mother offers the breast again he
becomes very upset, screaming and arching.  She fears that five minutes
isn't long enough to transfer enough milk to survive and is very worried
that he is getting underfed.  

He has many wet diapers every day and mother reports that he stools 'about
twenty times a day'.  Stools are 'slimy' according to mother.  This is her
second baby.  She breastfed her first for over a year, and wants very much
to enjoy breastfeeding this baby for at least as long, but as it is, neither
she nor baby are enjoying it much at all. 

I'll have the option of a pediatric consult when she comes to see me.  I do
have some thoughts about what I want the doctor to mull over with me.  I'd
feel more confident that the consult will be worthwhile if I could hear from
any of you out there with thoughts on what the differential diagnosis should
be.

Rachel Myr
[log in to unmask]
Kristiansand, Norway

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