Does this baby have any metabolic disorder? Williams syndrome or other? This baby needs further investigation medically, support mom's milk supply, monitor intake with scale or bottle-feeding. What is the suck doing, any tongue issues or barriers to effective latch?
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Colette
Sent: Monday, June 13, 2011 11:47 AM
Subject: difficult case (long)
Hello wise ones. We've come across a difficult case and was hopeful extra eyes on it could help with some ideas. I have permission to post as it is my baby ; )
Some history:
-mom "menopausal" pre-pregnancy as per OB specialist, 3cm fibroid present in uterus -9th pregnancy, 5th live born child (all pregnancy losses in 1st trimester).
2 c-sections, 2 vbacs
-mom 40 at time of baby's birth
-non-complicated pregnancy
-baby at 38 weeks gestation was found to be slightly transverse (head closer to mom's lower right hip) but ob's confident that head would move down with contractions -labor began at 40 weeks with steady contractions (every 5 min). no cervical change noted (2cm, 70% ). returned to hosp in 48 hours with cntrx every 2-3 min. no cervical change. labored for another 12 hours in hosp.
with cntrx every 2-3 min. ultrasound done, baby still in transverse position.
External version done. Baby moved, water broken and labor progressed. 1
1/2 hours later, cntrx changed and mom unable to continue(felt like something was wrong). cervix was checked, 3cm dilated but baby in brow presentation. OB recommends c-section. cntrx stopped with tributaline.
c-section performed. Healthy 9#2oz. baby born, skin to skin done in OR.
Breastfeeding in recovery room within 30 minutes.
-baby very spitty/gaggy after all feeds from birth -latch always tight (and continues to be at 10 weeks old), unable to adjust or she would just stop sucking -frequent nurser from birth (every 30 minutes)
-baby at 1 week old had a craniosacral treatment w great success, spitting up decreased for about 1 week.
-no bottles or pacifiers attempted until 3 weeks, greeted w gagging and spitting up large amounts (thought was a pacifier could help reduce spitting).
-baby's weight gain fine for first 6 weeks (1 oz per day) -mom removed dairy, wheat and soy from diet as baby was very fussy and projectile spitting out mouth and nose after all feeds. Spitting has decreased and is no longer projectile. spitting occurs about 5 times per day.
-at 8 week check-up baby dropped from 90% to 75%, weight gain now at 4oz per week.
-lactation consult revealed baby took about 40 ml. Fenugreek was started (3 caps 3 x/day) and pumping 3 times per day after feeds.
-4 days later, weight gain was 6/10 of an ounce. baby took 110 ml at this feed (feeds usually last about 1 hour w lots of switch nursing).
-baby now nurses often but nutritive sucking is not observed often. she does short little sucks and when milk lets down she will either cry, move her mouth so it pours out the corner. suck to swallow ratio is about 3-4:1.
spitting up still but not as frequent. baby is still quite fussy especially from 2-8pm. she sleeps at night anywhere from 3-5 hours and nurses better than she does during the day. if baby is sleepy she will nurse better.
-this baby is also quite sensitive...will jump at noise (like someone talking, sniffing nose, etc.) -baby has had copious wet cloth diapers and many yellow seedy bowel movements per day until 2 days ago and has only had 2 bowel movements in that time (both yellow) -a referral to early intervention has been made to investigate possible suck or sensory issues and an appointment has been made for another craniosacral treatment.
I and my IBCLC colleague are at a loss here...not sure what is going on and why this baby isn't gaining weight more, fussiness, etc.
Any words of wisdom would be appreciated.
Colette L. Baran
IBCLC, LCCE, CD(CBI), CHBE
Berkshire Nursing Families (413)743-5338 NARH & WIC
(413)652-3433
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