I've just started catching up on Lactnet after not reading it for over 2
weeks.
Forgive me, but at least I was doing work for the Academy of Breastfeeding
Medicine. <g>

Today I saw a 3 week old who is growing well but has been very colicky to
say the least.
No significant birth history, breastfed well. Weight gain of 23 oz (680
grams) in past 17 days
On about day 6 he began having fussy screaming episodes. Mom tells he will
latch well, suckle well and she hears loud swallowing and his stomach
rumbling. After a few minutes he squirms, comes off the breast and screams.
Mom has to use various holding and rocking techniques to calm him then
relatches him. Sounds like this is an ongoing process resulting in hour long
feeding episodes.
Mom doesn't feel there is much fussing between feeds but he wants to feed a
lot.
As she feels a strong let down and can pump with a single sided pump 4 oz (
120ccc) per breast. She tried single sided feeds without success.
Mom feels full pre-feed but not empty post feeds.
Stools were seedy yellow to smooth yellow, multiple urines.
Mom is driving herself crazy trying to eliminate multiple foods from her
diet.
Exam was normal.
Mom, at her wits end last night gave the baby a cows milk formula she had
from hospital discharge.

(pause as we clean up our vomit off the floor)

Today the baby was formula fed and mom pumped once for relief. The baby
seems better today not as fussy, slept well per mom.
He did once have breast milk in a bottle while mom was out and by family
report did well with it.
Avent bottle/nipple was used.

After my exam I watched the baby latch well, mom felt engorged, suck with
loud swallows , periodically come off them easily latch back on. Mom and I
talked basic colic support and treating for over active let down by using
side lying position, but the little guy doesn't like being lied down,
breastfeeding in a reclining position and if possible expressing milk per
feed. I gave mom the OK to use bottled milk and my beeper number.
After I left the room he flipped out a few minutes later but calmed with
holding and rocking.
Mom has good family support.

Any ideas beside mine of colic and over active let down?

Thanks,
Rob


Rob Cordes, DO, FAAP, FACOP
general pediatrician
Wilkes Barre PA
mailto:[log in to unmask]

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