A mom (cousin of a friend) called me from another state for help with her 7
mos old baby. This is her second baby--bf the first for 15 mos with no
difficulties. One month ago, the baby bit the mom while nursing, drawing
blood and a scream of pain. The baby has only latched on once since then. The
baby was introduced to solids at about 5 mos, but does not take large
quantities. A couple of days after the biting incident, the baby went to the
doctor for his 6 mos check-up and was found to have an ear infection. Mom
suspects the ear infection came first and may have led to the biting, but she
is unsure. She has been feeding her baby pumped milk in bottles since then
(did not find out what type of nipple she is using)--no formula at all, and
some solids. The mom called me from a cell phone on her way to the hospital,
so there are some things I didn't get to ask. I did forget to ask her if the
baby was given antibiotics.
A couple of weeks later, the baby was hospitalized with dehydration from
vomiting and blood-stained diarrhea. There were tests done for RSV, which
were negative. The doctor told the mom he did not know the cause of the
illness. The baby went home and the mom tried to win the baby back to the
breast with co-bathing. She said the baby just wanted to play and showed no
interest. The baby is currently in the hospital with a recurrence of illness.
Mom is desperate to get her baby back on the breast.
These are the seemingly unrelated issues. The first birth was easy--no
drugs or interventions.this birth was a cesarean after mom pushed for 2
hours--baby was stuck and mom's heart rate and baby's were both abnormal).
The baby never sucks for comfort--has refused a pacifier (used one with her
daughter) and finishes every feed in about 8 minutes (daughter spent about 45
minutes for most feedings). He has done this since her milk came in. Mom says
he is a very "high need" baby and has a history of being colicy and gassy. He
will take 8 ounces from the bottle in 8 minutes (seems to be his magic
number!). He has been a very rapid gainer, weighing 19lb at 6 mos.
I think it is likely this baby is responding to an oversupply problem. I
think he finds the bottle easier to manage, even though the flow is still
quite fast. Mom says milk supply is no problem, as she has always had a "very
abundant supply". She doesn't notice any sputtering or gagging, but has
noticed a significant difference in the way this baby feeds from her
daughter. My suspicion is he was keeping up with her flow, but only tolerates
it as long as he has to, and since she gave the bottles right away after the
biting, he no longer has to.
What do you all think? Do you think he may be getting an even higher
proportion of lactose in the pumped milk and he is being overwhelmed by it?
Do you think oversupply might underlie all of this? The other thing is the
baby has been to a chiropractor many times since birth. She says that the
baby is much less colicy after an adjustment, but the shift doesn't last.
We were unable to finish our conversation due to her arrival at the
hospital. I was able to ask her permission to post (she was very willing) and
to make a couple of suggestions. She will be calling me back for ideas from
you all. I suggested she try to latch the baby on when he is sleepy, that she
become an opportunist rather than just trying to latch him on at "feeding
time". I suggested she sleep with him (slept with her daughter, but not him),
that she put him skin-to-skin in a sling and that she either use a cup to
feed the baby or modify her feeding of the bottle to slow down the feeding. I
was not able to discuss how she is pumping, so as to assure a balance of milk
constituents, nor was I able to ask about drugs given to the baby. I do know
he was given pedialyte when the doctor told the mom to feed the baby her milk
and wrote clear fluids on the "orders". The nurse refused to allow the mom to
give her milk and gave pedialyte, until the mom was able to track down the
doc and get back on her milk. I did briefly discuss food allergies, but had
no time to get further into it. I am hoping to have ideas from you before I
talk to her again.
I would consider suggesting a nipple shield, but am wary of doing so w/o
being assured of a capable LC she can work with. She is not comfortable with
the skills of the LC in the hospital where her son is. I will find out her
specific location when we speak and maybe someone on Lactnet will be near her.
Jennifer Tow, IBCLC, CT, USA
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