Hello Lactnet Friends,
I am looking for you collective wisdom on this case which I can't seem to
sort out. Presenting problems are sore nipples since birth, slow weight
gain, low milk supply. I cannot tell if the poor sucking is causing the milk
supply problem or vice versa. With all the measures mom has taken it seems
impossible for her to have a low supply. Not sure how mothers emotional
history might be playing in. Basic facts are below for your consideration. I
would be grateful for help with the next best step to assess and solve this
problem.
Judy Gutowski, BA, IBCLC, RLC
Breastfeeding Matters, Hannastown, PA
Recertified 10 years (Glad that is over for another 10)
Birth Date: 10/15 - 7#4, Discharge 10/18 - 6#0, 10/20 - 6#4, 10/24 - 6#8,
10/28 - 6#10, 11/7 - 7#1, 11/14 - 7#10 with supplement, 11/22 - 7#12, My
Initial visit 11/23 - 7#3.3, 12/2 8# 5.8
Initial weight loss of 20 oz in first 3 days of life before hospital
discharge and while receiving supplements in NICU due to elevated temp after
a prolonged labor. Low weight gain weeks 1-3, supplemented with 2 oz of
formula per day at 4 weeks. Mother taking Reglan 45 mg/d prescribed by ped
and pumping with rental pump but did not notice increase in supply. Mother
had tried supplementing with SNS but it didn't work for them.
Maternal history includes multiple factors possibly leading to impaired
supply - age 37, anorexia and amenorrhea in early teens, recovered
alcoholic, depression. Recent 2.5 years amenorrhea. Clomid 3 times to
achieve pregnancy. Fertility docs found no obvious reason. Normally very
thin, active. She describes her breasts as giant compared to before.
Initial suck assessment - good technique, but feeds very slowly. Test weight
- 40 minutes feeding =1.5 oz intake. Lingual frenulum far enough back, but
is tight possible that he is fatiguing due to effort required to keep the
tongue forward.
Friday 11/25 to Sunday, 11/27 increase the supply with 24 Hour Sure Cure
while monitoring diapers and checking weight Sunday or Monday. Working with
breast compression and observing for active swallowing. Mom reports constant
feeding during this time, but much of it as non-nutritive. Weight check
showed no gain 4 days.
11/28 visit with new pediatrician. Pumped and gave al feeds by bottle and 8
oz formula in past 24 hr weight up 8 oz. Tongue clipped, no problems
resulted, mother felt he fed better immediately. Domperidone prescribed 30
mg/d.
12/1 Domperidone started 11/29. Mom is also using fenugreek, blessed
thistle, and oatmeal. Nipples still sore. Weight increase 1 oz/day.
12/12 Weight gain still slow. Mother reports she is pumping less 1 oz less
than she could get before when pumping in place of feed. Supplementing with
formula. Baby never satisfied, feeds constantly. Nipples are sore even when
pumping and compressed after feeds. Suck is now more disorganized and
inconsistent. Gagged on finger with normal insertion that was used in last
assessment. No evidence of thrush in mouth or on nipple, but is a
consideration since both received antibiotics weeks 1and 2. Labial frenulum
is also tight and difficult to pull out but mother succeeds occasionally,
but appears to for a seal well around nipple. Suggested CST today. Mother
says his head was very misshapen at birth. Mother and I are considering
exclusive pumping for a time and bottle feeding to empty breast better. Pre
and post feed weight was .6 after both breasts - 30 minutes. He went back to
feed again on both after that before he seemed satisfied.
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