Hi all,
I have just started, over the last month or so, seeing private patients after
relocating my practice from the Boston area to sunny Sarasota, Fl and one
baby in particular is wearing me out!
She is now 7wks old, I have seen her twice in her home -at 8 days and 6 wks.
The first consult was requested by Mom d/t fussiness or sleeping at breast,
frequent feeding Q1-2hrs around the clock, discomfort w/gassiness. Positioning
assist provided great relief but baby did have state control issues ie. fell
asleep quickly at breast despite stim while too much stim caused irritability,
she also had some trouble managing flow d/t lg supply. Numerous phone calls
over the next 2 wks revealed good wt. gain ;1lb over 2 wks and some improvement
to above with usual measures.
Call received again at 4-5wks when Mom reported 1 good wk-baby slept more
regularly, fed more calmly, cried less but had deteriorated back over previous
few days to very little sleep, etc. , -basically all of symptoms as above in
addition to newly sore nipples and questionable thrush of baby. Mother also
reported that baby made loud "choking" noises erratically throughout night which
she reported to pedi. Mother tried to obtain GV and APNO w/o success and
reverted to nystatin to baby. Worsening of symptoms caused her to request another
visit at 6wks.
6 wk visit revealed cont'd fussiness/sleepiness at breast but now w/o
overactive letdown as supply had diminished greatly -thus neither symptom appeared
flow related. she continued unhappy when not feeding, as well, sleeping little,
stools-nl, belly soft, tongue with lt-mod wht coating consistent w/ thrush ,
negative to buccal pad, mom eats little dairy, discussed possible reflux w/pedi
but baby spits little. nipple soreness was greatly relieved w/ positioning
changes
Although not convinced, I felt first approach should be to treat for candida
infection to Mom and baby. We successfully tracked down gv which she has used
for past 4 days with little change to tongue coating. nipple soreness persists
but is much abated d/t position changes rather than gv use per Mom. Baby has
been sleeping a little better but continues fussy at breast. Mom has since
offered first bottle/EBM which baby drank quickly and happily and now she is
tempted to continue this.
WHAT is going on here? I am now thinking that it must be blind reflux but
baby doesn't arch back, head of bassinette has been elevated since my first
visit. Mom has baby b'jorn and sling which she tries to use often. I have
suggested d/c 'ing use of nursing pillow as this forces baby to lay flat with feeds
and encouraged elevating head and shoulders. Mom will be reluctant to change d/t
nipple pain.
Any thoughts???
Lynn Shea Rn,Bsn,Ibclc
Lakewood Ranch, Fl
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
