I saw a really strange case today.  Baby fed and grew fine for 2 1/2
months.  At that time he began to not want to feed at the breast.  He would
feed only if he were drowsy and falling asleep.  Then he would feed in his
sleep for 10-15 minutes.  He refused to feed if he was fully awake.  Mom
would have to walk and sway until he was fading out, then sit down slowly
and he would go to the breast.

His 3 month checkup was ok, but at the 4 month visit ( Tuesday of this
week) he had gained only a couple ounces.  [Birth weight: 7# 3 oz. 4
months: 11# 13 oz] From 2 1/2 months he was not happy unless he was held
and he resisted any attempt to get him to the breast. One might think that
he had just plateaued in wieght, but his intense rejection of the breast
indicated that he wasn't just a baby who was gaining slowly. Something was
wrong.

The doctor (one of the least b'feeding supporting Peds in the area) advised
alternating feeds of abm and breastfeeding because mom's milk doesn't have
enough fat.  Baby refuses bottles.  He won't suck on a finger either.
Parents have been "forcing" him to take abm with a spoon and it takes both
of them to do it. In 24 hours he took 5 ounces of abm, and yet he had 8 wet
diapers and 4 stools, so he must be getting breastmilk.

Mom is not on birth control hormones and said that the only change to her
diet was a lot of chocolate, because she was too busy to eat in the day.  I
recommended that she eliminate that in case baby was rejecting the milk
that could have been causing gas pains and that she focus on eating well.

When I saw him it had been 5 hours since he had eaten and he was happy
until mom put him in the feeding position.  She cradled him and walked
until he began to grow sleepy.  She sat down and he latched on, fed
sleepily for about 4 minutes, then looked up and grinned.  He wouldn't
latch on again until she walked him to sleepiness again.  This time he fed
for about 8 minutes and stayed asleep.

He grew in length and head circumfrence during that month and, with his
overall weight gain, I would say there isn't a thriving problem if he
weren't so resistent to feeding when he is hungry.  He looks healthy--a bit
thin but not overly. He is bright-eyed and playful. He responds gleefully
to his parents' talking.

Mom is not negligent.  She is gentle and most loving in her interaction
with him.  Dad is too. He was helping with the spoon feeding by
entertaining baby so that he would not be aware that he was feeding.

Pumping to feed him doesn't do any good, because he won't drink it.  I
suggested that she pump so that her supply stays up.  It looks as if most
of his feeding is done at night.  He sleeps with the parents. Still his
feeds are short, but morning diapers are soaked.

I wish that I could have seen him at the beginning of the problem.  I
wonder if there could have been some foremilk/hindmilk imbalance at first,
and mom was trying to get him to feed, thinking that he was fussy because
of hunger.  If she was forcing him to the breast he could have grown
resistant.

Oh, I don't know if that makes any sense.  I am quite puzzled as to why a
baby will not feed when he is hungry. I'm open to any and all suggestions
or guesses.

I suggested that she take advantage of his willingness to feed in his sleep
and to feed him as often at night as she can.  I also recommended skin to
skin when she is holding him in the day, and also massage.  I forgot about
co-bathing.  That might help the too.

Pat Gima, IBCLC
Milwaukee, Wisconsin, USA
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