Hello, wise ones. I am hoping some of you have encountered a similar situation. I have permission to post from mother and father of baby.
Four month old baby girl. Third baby for this mom, first that she's nursed this long. Mother very committed to nursing this time, did not nurse over six weeks with others. Mom started out giving AIM via bottle and nursing when this baby was born but has been exclusively nursing for past six weeks or so, after my counsel. 
Baby was diagnosed with reflux at 2 m.o. and given zantac and reglan, but mom didn't tell me this until recently. M
has not been giving meds consistently and baby hasn't been to Dr. since
2 m.o. Both parents unemployed.
This is what's going on:
Baby is extremely active while nursing. I mean, she looks like she's gonna try to stand up any moment, but keep nursing. When she nurses, she grabs tight handsful of breast and pulls up away from her mouth (not pressing against breast, but pulling skin) while at the same time sucking very hard on nipple and pulling and stretching it in opposite direction from where she's pulling with her hands, all while sucking and then kind of stripping nipple until she pulls off, then latching back on and repeating. She starts this within a minute or so of beginning to nurse. Meahwhile she remains a wiggle worm.
At first observation, she appears to be a baby who is extremely impatient and dissatisfied with the flow. No way mom can do compressions because she is nursing in defense mode, only being able to tolerate baby's actions for a few minutes at a time before she has to stop and take a break for a minute or two before going back to it. Needless to say, mom is suffering through great pain and is extremely tolerant, under the circumstances. I realize there's no way baby is removing milk efficiently in light of this. Mom's been pumping but is now too sore to tolerate that as well.
I saw in clinic earlier this week and strongly urged mom to go to Dr. bc maybe what looked like impatience on baby's part was pain from reflux. (No formula, mind you.) Baby is pulling off and latching back on, stretching tissue between hands and mouth and wriggling around, never settling down and nursing peacefully. I tried compression while baby nursed and she did settle about 50% for maybe 1-1 1/2 minutes, but only once. Milk is dripping from mom's nipples when baby pulls off and baby is swallowing at about 2-3 sucks per swallow, when she's sucking. Baby doesn't act upset and doesn't fuss, just nurses and pulls until mom has to break suction and try again. Baby is nursing every hour at least, and doesn't sleep much, maybe because mom is always having to cut nursings short becasuse she can only tolerate for 10 minutes or less.
I suggested baby might be reacting to pain from reflux and mom might try nursing baby in a modified football hold, with mom leaning back slightly and baby more upright. Suggested dad try holding one of baby's hands and stroking her in relaxing manner while mom nurses. Strongly recommended she go to Dr. right away to make sure meds and dosage were right and pointed out to mom that if is was reflux, she must be consistent with meds for them to be effective. Also, Dr. could rule out other causes and for her to just explain how committed she was to exclusively breastmilk for baby.
Mom called tonight in tears saying she was gonna have to start back with formula and quit nursing altogether because she just couldn't stand it any longer, it was just too painful and too much a struggle. She was heartbroken. They had just given baby a bottle and although she did still wriggle a lot while nursing, she did not clench or pull the nipple, not did she pull on and off. She said after she met with me things seemed a little better for a day or so. She says now baby is always using both hands to grasp and she has been having to nurse every half hour bc she can only nurse for very short times. 
She says daddy has tried holding baby's hands, but it just makes baby very mad. 
I validated her feelings, and offered that although I agreed she needed a break from nursing, it did not necessarily mean she was gonna quit for good. But, we do need to get a handle on what's going on. Suggested they cup feed baby in the meantime. She seemed encouraged by that.
Pumping is too painful so instructed on hand expression and urged her to go take a shower and practice while there. 
She is to call me in the morning and later in the day I will do a home visit and we'll work on hand-ex and cup then. I'm gonna take starter SNS with me because if she'll nurse with it and settles down, it's a flow issue I figure. I'm just trying to get a clue. But, I swear I have never seen a baby do like this before and I'm just at a loss, otherwise. 
I told her I had over two thousand fellow lactnetters and before I went to sleep tonight, I'd post and ask for your input. So, there is that. Feel free to ask me for more info, on or off board. I appreciate all I have learned from each of you and apologize for the length of this post.


The miracle is this--the more we share, the more we have.
--Leonard Nimoy
 
Liane C. Varnes, CLC

Certified Lactation Counselor
Lactivist
Peer Breastfeeding Counselor
Georgia Public Health District 2 - WIC Program



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