Dear Trish,

Well, I have a lot more questions than answers on this one.  First of all, you say that this is a local mom that you are counseling by email.  Are you an IBCLC, LLLL, ???   This mom needs to be seen by a competent IBCLC.  Although it is possible that there is a lot of misunderstanding here, it is never normal for babies to be coughing and struggling at the breast - and certainly an 8 wk. old baby is way past the learning how to breastfeed stage, so I don't know what this LC she did see was thinking.  What was happening for the first 6 wks?  How is the weight gain?  How many times a day is she nursing and for how long?  Was the  baby ever evaluated by the ped while he was actually at the breast?  Have you actually ever seen this dyad?

This is not a slam against you, Trish.  I don't know how much experience you have or what else has gone on with this case.  However, when people post with case histories, it is difficult to give any suggestions when so much basic info is missing.  Also, in many cases it is really going to be close to impossible to help a mom and baby unless someone who knows what they are doing sees them and does a thorough examination and evaluation.  I've done counseling by email, but I don't like it much unless it is a simple question or problem.  Otherwise, if I can't see them, I don't feel that I can ethically try to help.  Same thing with stuff over the phone.  Supporting a new mom with a pat on the back and basic breastfeeding stuff is one thing.  Once a problem has gone on for a while or if baby is not thriving, then someone has to see them or in most cases, there will not be a resolution, except for weaning.  I'm not saying that long-distance counseling can never work, but it's very difficult and leaves most LC's feeling very uneasy as the process continues and the LC is never really sure if what she is hearing described is what she would actually be seeing if she were there.  It's better than nothing, but it's not a great solution in a complicated case.

This could be many things.  The coughing while nursing strongly indicates a problem regulating swallowing and breathing or it could be an allergy to something in the milk which is irritating the baby's throat.  Crying at the breast could indicate both milk insufficiency or oversupply, depending on other presenting  behaviors.  Baby could be very uncomfortable due to a physical problem.  Baby could have reflux.  The list is really endless here.  If you are a LLLL, then you need to contact your APL and get some help.  If you or someone else you trust can see this mom, then that should be done right away.  If there is nobody experienced in your immediate area, then you may need to look for someone a little further away.  If this mom really wants to keep nursing, a long drive to see a really good LC would be well worth the effort. There are no easy answers here.  Keep us posted on how things go.  Good luck.

Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
mailto:[log in to unmask]

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