Lactnetters,
Permission to post
I met yesterday with a mother of a 5 day old baby. He was born at 39 week 3 days
and latched while in hospital but required assistance to latch. At discharge, OB
told parents that forcep assisted delivery had "paralyzed the baby's bottom lip"
but t it "wouldn't impact breastfeeding."After discharge, he refused to latch at
all and only cried or fussed with occasional licks at nipple. He had a 24 hour
period with no urine and excessive sleepiness on day 2-3 and parents took him to
ER for evaluation. He had brickdust when he finally peed (one ER Dr. called it
brickdust; one ER Dr. called it a "male period from mom's hormones"; I showed
family pictures of brickdust and they felt confident that was it). ER dx
stridor/"floppy airway" (while bottlefeeding supplement) and dehydration and
recommended continue supplementation with formula and a ped appt "ASAP". Since
that ER visit, the mother has been attempting to feed 'often' (approx every 2-3
hours) and offering supplements after every attempted feed. Baby is taking
4-10oz a day via supplement and getting "one - three really good breastfeedings"
a day. He will randomly latch on and nurse well and the rest of the time he just
fusses at breast, cries and licks or latches for a couple of seconds then pulls
off and cries more. Mom has been fairly aggressive about pushing breast on baby,
which may be complicating the situation. In addition, the couple is multiracial,
and there is some tension between parents over proper baby care (father
uncomfortable with supplements and supportive of breastfeeding but doesn't
understand why it didn't just work from the start).
I worked with the family for about two hours. We attempted laidback positioning
and other positions (football, cradle and cross cradle holds). Baby does not
have tongue tie and he did seem to have a slight dimple on bottom lip, but
seemed to be able to control it. He was well hydrated and had normal quiet alert
state during my visit, except when mom was trying to encourage latching. The
closest he came to latching on was toward the end of the visit after having been
skin to skin for most of the visit. he latched for about 20 seconds, then pulled
off and laid back on mother's chest. I never observed a suck/swallow pattern or
even a latch on long enough for me to really evaluate it (the best one was
somewhat shallow). Baby seemed to be breathing normally without difficulty, even
while crying. I didn't observe a bottlefeed. They saw the ped today, but I
haven't heard back yet. They are using a pacifier some in addition to the bottle
for supplements.
What are your thoughts? I am concerned that baby has some airway/structural
issue (stridor??) that is impending normal breastfeeding. I advised mother to
keep ped visit, relax with baby skin to skin more often, pumping to maintain
milk supply (her milk had just come in), and continue supplementing as needed.
I've done home visits for the last several years with LLL, so while I am a new
IBCLC, I am not completely 'green', but I have never seen anything like this! I
don't feel like I helped much at all and feel slightly guilty for taking their
money. :( This was my first paid consult as an IBCLC.
Looking forward to your thoughts,
Cassidy Hotz
central Oklahoma, US
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