Hello LactNetteers!
I have had a puzzling case this week and I need help, please. I have mothers
permission to post.
Last monday a Mother called me and asked help. I havent seen her and her
daughter, they live in another city quite far away. Then she sent me a
qouple of SMS and email and i have emailed her back. Here is the story:
Mother is 34 year old healthy, experienced nursing mother, normal pregnancy
and delivery. So normal that they went home less than 24 hour after
delivery. The Baby is now 1 month old and the main problem is weight gain
and painful nursing (breast are sore and there seems to be some kind of
wound also at least part time). The mother is tandemnursing 1y 4m old
sibling who nurses twice a day. The Baby usually nurses first and the
Brother after her.
Nursing has been painful since the birth and the mother asked help from the
pediatrician who checked the Baby before departure. The pediatrician said
that there is no tongue-tie. The mother says that the Baby does not open her
mouth wide and at the beginning the Baby sucked easily the lower lip with
the breast. The Baby is also spitting up and has a lot of gas and is crying
a couple of hours in the evenings. The Baby has some kind of rash. Mother
said that she seems to have over-active MER at some nursings. The Baby has
been treated for trush some time ago by home maid treatment (lingonberry).
Baby nurses only 6 (-8) times per 24 hours.
The weight gain is here:
Birth 3510 g, height 50 cm (17.8.)
Two weeks 3840 g (31.8.)
3,5 weeks 4180 g, 54 cm (12.9.)
1 month 4070 g (17.9.)
(18.9.) Baby at the hospital 4065g, 54 cm
The Baby was sent to the hospital for evaluation when the weight went down
and was admitted. She was tested for pyloric stenosis and it was ruled out
by ultrasound, no abdominal anomalies was found. The bloodwork was normal
(infection, liver enzymes, electrolytes and NH3 values) so there seems not
to be any metabolic disorders. They did test weigts and the Baby took up to
130 ml / nursing. No supplementation was not done or suggested!!! (They
thought that the sibling maybe takes too much of the Babys milk which I dont
suspect.)
So it seems that we are back to the basics: latch (talked with the mother
about getting more asymmethric latch), over-supply due to tandem nursing (I
have talked with the mother about letting the Baby drink from the emptier
breast also) and OAMER. I think the baby does not get the fattiest milk due
the lacth and manadgement and due to discomfort does not nurse often enough.
The Mother is going to see the bf support group leader at her home town to
asses the latch further. I encouradged the Mother to nurse 1-2 times more /
24 hours but the Mother thinks that the Baby does not want to nurse more
often. I hope she will consider still nursing more often. The Baby sleeps
6-8 hours without waking at night and I suggested that if the Mother wakes
up on her own she could try to put the Baby to the breast.
I am so frustrated since I know there is something wrong with the latch /
babys sucking but I dont know any MDs at her hometown / in Finland to send
her to. I know that many mothers have had help with tongue-ties in Finland,
but if this is a more subtle one, there isnt anybody we could refer for
sure. I encouradged the Mother to get a proper thursh medication, and as I
was writing this I realised, that the Babys diaper rash and slowly healing
nipples might be the trush complicating healing.
Any other suggestions?
Hopefully,
Pia Ruohotie, RN, breastfeedign counsellor
From Helsinki, Finland, Europe
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