> This infant is very stiff.  Not easy to hold, not "cuddly".  I have
> notice this stiff posture with several other infants who were slow
> weight gainers.  Don't know it there is a connection.  I will follow
> with her through the month.  Any other ideas?

Yes. In a nutshell, have baby sleep in the car seat and do baby massage.
This particular baby will benefit for 2 reasons: 1) as a cardiac baby,
cardio-pulmonary function will be vastly improved in the upright
position with a lower calorie expenditure on just breathing, and 2)
being in a hip-flexed and neck-flexed position relaxes the baby and
makes subsequent positioning easier. Based on observation (anyone chime
in if you know of research), flexed babies eat better and digest better,
suggesting to me that torso-flexion enhances  parasympathetic nervous
system functioning which is where digestion is controlled.

I remember something about neuromuscularly "tight" babies - the more
erect posture or "back-archers" - being more prone to ineffective or
sub-optimal suck-swallow behaviors because of their underlying
"tightness". I stress to parents I work with (because they are thinking
it if they don't ask) that this can be "within normal limits" of infant
behavior (less than 1 year) and is *not* usually linked to cerebral
palsy. I am extremely careful about what words I use in this instance.

Then I demonstrate with the parents. I have them throw their heads back
like the baby does, and ask them to swallow. (You can try it now, too,
if you like!) Not easy, is it? Not easy for babies either. Now drop your
head forward and swallow - easy. Once parents experience it for
themselves, then anything I offer that follows makes sense to them.

I'm presently working with an experienced BFing mom (3rd baby, nursed
others to 18+ mos) who has a neuromuscularily "tight" baby. When I first
saw them 3 weeks ago, at 4 weeks postpartum, mom was pumping and
refeeding all feeds. To BF this little one - who was a mighty
"back-archer" - the position would have required the baby's face to be
at the breast in the usual manner, but the body supported nearly
perpendicular to the breast (straight above mom's legs). You have seen
these babes I'm sure. Also, talk about fussy - whew! Cried all the time
- nearly inconsolable - and no routine to speak of (these are Ezzo
trained parents who fortunately have the common sense to suspend the
program in favor of the baby's needs :-D  )

After doing baby massage (especially effective for this one was
massaging the belly while lying on the lap with hips flexed against
mother's chest), mom & baby nursed 45 minutes - thoroughly & happily.

Three days later, "tight" set in again and BFing fell apart. I revised
the plan to include having baby sleep in her car seat, because it
requires flexed hips (and flexed neck, too). Daytime became organized
almost instantly; nights still out of control. Turns out parents were
putting her flat on her side in her crib at night which let her return
to back-arching. I finally convinced them to let her sleep in her car
seat at night too. She started sleeping through the night almost
instantly (she weighs 9#8). I reminded mom we were providing physical
therapy of sorts - in this case, retraining baby's back muscles to be
relaxed (longer) which encourages the whole system to function better.
Eventually, baby would be able to hold these positions on her own. She
has certainly become an easier baby to snuggle, happier, and BFing
positions are a far sight easier, too!

Incidentally, the labor history was revealing for this BF problem.
Although it was a vaginal delivery, mom had progressed very slowly
through first phases of labor, then suddenly took off. Baby was born
with extreme bruising all over the face, as in blueberry purple bruises
- from hairline to chin and cheek to cheek. My speculation is that she
had been a facial presentation for a while (possibly for days) and then
somehow was able to get into a vertex presentation, thus delivering
vaginally. If baby were stuck in a facial presentation, even for a few
hours I suppose, it would certainly account for her back-arching
abilities.

Katharine West, BSN, MPH, IBCLC(exp)
Sherman Oaks, CA