I would be very concerned about a baby with a heart defect who is not gaining
properly and is "stiff." Failure to thrive (FTT) babies AND infants with
unrepaired heart defects frequently have low muscle tone; and it is not
unusual for infants with low muscle tone to compensate for their poor
proximal control by 'fixing' their joints and appear stiff. Flexing the
baby's hips to 90 will probably break up the extension posturing, but the mom
needs to compensate by providing diligent trunk and head support.  Poor
gaining infants with heart defects need careful control of their intake and
calories- too high a volume of milk, whether human or manufactured, may put
them in fluid overload and subsequent heart failure. Some (a small minority)
of these infants need 27 calorie/oz feedings, something which would be very
difficult to take at the breast, but not impossible. I wonder why this infant
is not scheduled for surgery to repair this problem? Is this infant being
followed by a pediatric cardiologist?  This mother and baby need your support
and advocacy to continue breastfeeding, and you may need to assist her in
refferrals to appropriate specialists who are supportive of breastfeeding. If
you are still concerned about this baby's tone in a month or so, a referral
to a pediatric OT or PT may be indicated.

Debbie Rabin, OTR, CLC
Los Angeles, CA