Several weeks ago I posted about a dyad in trouble.

Baby didn't latch for three days after birth (unmedicated, nvd).  Gave
formula via syringe and *large* attached tube - by letting baby suck on
the tube per instructions from mw's at birth center.  Born at 7#5,
lost?, at 11 days, weight was back up to 7#5 (different scale), 31 days
after that, weight was 8#8.

All the while, no supplementation but breastfeeding going very badly.
Plugged ducts, mastitis, constantly fussing baby.  Would latch, nurse,
transfer milk for a minute or less, would suckle more, fuss, mom would
switch breasts, baby would get another letdown and the cycle would begin
again.  She felt that he was only nursing 'well' approx two times per
day.   He was having adequate wet and poopy dipes.  Ped felt he was fine
per weight gain "just keep going, it'll get better".

At that time, ped referred her to LLL, which ended up not being very
helpful for her situtation.  Good moral support but not enough technical
expertise.    A bit later, Mom 'heard' from a friend that there were
LC's at one of the Atl metro hostpitals.  Mom drove a very very long way
to see them.  She was told that her baby was malnourished and dehydrated
(which was what mom felt as well).  baby hadn't gained any weight in 14
days, still weighing 8#8.   No stool in several days, two wet diapers in
the previous 24h.  They gave the baby 4oz of formula in a bottle there,
which he drank hungrily.   IBCLC/former LLL leader recommended pumping
post feeds and feeding that as a supplement to baby - and if there was
no output from pump, to supplement with formula per baby's appetite.
IBCLC/LLL'er said that the latch 'looked fine' but that they should
visit the feeding specialist at the cranial/facial disorders clinic at
one of the children's hospitals.  Referral was given.   No suck
assessment was done, SNS not mentioned, no mention of the difference
between pumping with a hospital grade pump versus the PY that the mom
already had.  Mom was sent home with instructions to
feed/pump/suppplement on a three hour schedule around the clock b/c more
frequent feeding would be wasting calories that this baby needed.

It was several weeks after this, that a mutual friend put us in
contact.   I met with the mom, who made it clear that she would do
*anything* to breastfeed this baby, that formula and bottles weren't at
all in her plans for mothering and that changes needed to be made.  She
also made it clear that the pumping was no productive and very very
stressful.  She didn't feel she could do it any longer.   Another friend
of ours gave her an SNS, which she's been using.  She also immediately
started MMP and Goat's Rue tinctures. Noting breast size changes and an
increase in supply very quickly.  With it,  plugged ducts reappeared.

Baby was fine with the SNS.  Mom loved it over bottles.  Domperidone was
on order.    Baby gained very quickly....essentially 'caught up'.  She
stopped using the SNS at night.  Slowly, she cut the formula back from 4
oz every 3h to 2.5oz as needed.     things seemed to be going well.

Then baby again began to fuss during the night, but was happy if she
used the SNS......then he began drinking more formula during the day.
The domperidone arrived two days ago - she's started it.

Two days ago, she also went to the feeding specialist who said:  " latch
and palate are fine....his palate is high, but not high enough to
explain the problems that are present.  He nurses actively, then seems
to stop to breathe"  she went on to explain to the mom how babies have
to organize their suck and breathing. then "you'll have to pump your
breastmilk, then feed it to him from a bottle.  Because the bottle is
further away from his nose, he'll be able to breathe better".

Wow.  Winning statement.   Mom, not missing a beat says "he's nursing
now and my breast is nowhere near his nose.   I thought that if a baby
was being held properly, then the chin was pressed into the breast
tissue and their nose was free and clear?"  (she just got done reading
Jack's book that I loaned her).  the specialist ignored her and went on
to say that a referral to an ENT was in order to find out why he can't
organize his breathing/sucking/ swallowing. She also asked if he seemed
to snort and snore?  Mom replied that he does.   Specialist felt that
was relavant.  Specialist also felt that it was problematic that baby
was in the 75%ile for height and only the 25th for weight and that mom
needed to 'fatten him up a bit' by making sure that he finished at least
four ounces of formula every three hours.   Mom tried that for two
feedings and it felt all wrong.  He didn't want it.   He kept turning
his head away and fussing.  She's back to supplementing formula per his
cues (all at the breast)

Okay folks.   Any and all theories are welcome.  Mom isn't the least bit
interested pursuing another specialty consult.  Baby is extremely happy,
meeting developmental milestones.  Mom did have a biopsy done in the
upper right quadrant of her right breast for a suspiscious tumor several
years ago.   Some of the plugged ducts were in that area, but they've
also been in other places on that breast and on the other breast.  No
other breast surgeries.

What's going on?   Something that really warrants further consults with
specialists?  Something that the baby will outgrow?   I keep thinking
back to another friend who's baby was mis dx'ed wtih Pierre-Robin
syndrome.  She just had an exceptionally recessed jaw that made it very
difficult to nurse, paired with a mom who's supply is "just" enough
under the best of circumstances.  The combination wasn't a good one.
Baby didn't nurse well with the SNS.  Mom was able to supplement formula
via bottle, while nursing often - ending formula supplements at around
five months and continuing breastfeeding.  She's still breastfeeding and
must be over two.  The difference in the appearance of that baby's jaw
between 6 weeks and five months was *phenominal*.

To me, it would seem that a primary supply issue (IGT) on mom's part is
ruled out b/c even though he was unhappy, he was gaining well enough
during those first six weeks.   Thoughts?  Theories?

katherine in atl

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