Hello, Chayn.
       I am some thoughts, but I'm typing them in no particular order here.
In my head, some seem to contradict each other, but maybe they will come out
better "on paper".  :)
       Considering that baby probably lost a bit of weight after birth, this
baby has gained at least 5 pounds in 7 weeks.  That's a lot, which made my
think of overactive letdown, which you confirmed later in your description.
Having worked with breastfed babies for more than 20 years, I can tell you that a
lot of them "change" at around 6 weeks.  It's as though at that age, they
suddenly/finally realize that they have some CONTROL and can say No to situations
they don't really care for.  If they have been tolerating an extremely fast
letdown, at 6 weeks they often decide they don't want to tolerate it anymore and
change their breastfeeding "style".  Some refuse the breast altogether
because they are tired of the trauma of drowning.  (Well, at least that's my take on
it.  Obviously, I can't ask them!)
       This baby may have realized that if she doesn't open her mouth as
widely, she triggers a slightly less wild letdown, which may feel better to her.
I have seen that babies who don't draw mom's nipple back into the mouth as
they should, or who are being bottle-fed due to problems in the early days and
parents are only putting the short shaft of the bottle nipple into baby's
mouth--rather than the whole length of the nipple--frequently gag when I try to put
a bottle nipple all the way in, or do a digital suck exam.  It seems to me
that once they stop getting the nipple on the back of the hard palate, they
temporarily lose the ability to tolerate touch on the back of the hard palate and
then start gagging at such touch.  As I show parents how to gradually push the
bottle nipple further into baby's mouth (over the course of a few feedings or
a few days, depending on severity of problem), often the gagging gets less and
the babies also seem to naturally just take in more of mom's nipple.  So if
this baby you are working with has by choice decided to slide back to the end
of the nipple in an effort to trigger a slightly less hectic letdown, she may
now, 3 weeks later, be having this problem.
       Another thought--maybe with the frequent mastitis in the early weeks
there were also plugged ducts (possibly deep enough that mom couldn't feel them
with her fingers).  The plugs, though possibly caused by oversupply, may then
have backed up the milk/slowed down its flow in the affected duct(s).  When
mom finally got the mastitis under control, perhaps there weren't any plugged
ducts happening to slow the flow, so at that point baby needed to change her
nursing style to account for faster flow.  After a couple weeks of this
"sloppier" nursing style, which probably wouldn't drain the breast completely, mom's
got another bout of mastitis.  (I'll admit this last scenario seems a bit of a
stretch, but I'm brainstorming here!)
       Even though your question is about the baby, one of your sentences
about the mom concerned me.  If I understand your description, mom has had at
least three infections in the same place in the same breast.  Although this might
be that the original infection was never really eradicated, this mother may
also need to consider asking for an ultrasound to rule out something growing in
that part of the breast that is blocking milk flow and leading to milk
back-up/mastitis.
       Since mom has "plenty" of milk despite baby's poor latch, I'm betting
that baby is now getting mostly foremilk.  She is not comfortable at breast to
stay on and get the hindmilk, so now she is probably also suffering from
foremilk/hindmilk inbalance, which would account for the gassiness.
       Although this probably isn't the case if baby was really latched on
well without problems in the first six weeks, some babies gag as a protection of
the airway when they have swallowing problems.  (The gag propels the food
back out of the mouth, rather than allowing it to get to the airway.)  If slowly
trying to desensitize this baby's hyperactive gag reflex doesn't seem to yield
any improvement in 3-4 days, it might be wise to talk to doctor about a
swallowing study to be sure baby isn't at risk of aspirating her feedings.
       Dee

Dee Kassing, BS, MLS, IBCLC, RLC
Collinsville, Illinois, in central USA

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