Katherine.... There are a lot of "cooks" in this broth....seems like.

>Baby didn't latch for three days after birth (unmedicated, nvd).  Gave
>formula via syringe and *large* attached tube - by letting baby suck on
>the tube per instructions from mw's at birth center.  Born at 7#5,
>lost?, at 11 days, weight was back up to 7#5 (different scale), 31 days
>after that, weight was 8#8.

That's is a 19 oz gain in four weeks. That is a little over 4 oz/week.
Slightly under normal.


>All the while, no supplementation but breastfeeding going very badly.
>Plugged ducts, mastitis, constantly fussing baby.  Would latch, nurse,
>transfer milk for a minute or less, would suckle more, fuss, mom would
>switch breasts, baby would get another letdown and the cycle would begin
>again.  She felt that he was only nursing 'well' approx two times per
>day.   He was having adequate wet and poopy dipes.  Ped felt he was fine
>per weight gain "just keep going, it'll get better".
>
>At that time, ped referred her to LLL, which ended up not being very
>helpful for her situtation.  Good moral support but not enough technical
>expertise.    A bit later, Mom 'heard' from a friend that there were
>LC's at one of the Atl metro hostpitals.  Mom drove a very very long way
>to see them.  She was told that her baby was malnourished and
>dehydrated  (which was what mom felt as well).  baby hadn't gained any
>weight in 14 days, still weighing 8#8.   No stool in several days, two wet
>diapers in the previous 24h.


Not good.

>They gave the baby 4oz of formula in a bottle there,
>which he drank hungrily.   IBCLC/former LLL leader recommended pumping
>post feeds and feeding that as a supplement to baby - and if there was
>no output from pump, to supplement with formula per baby's appetite.

This could have been done at breast with a feeding tube.

>IBCLC/LLL'er said that the latch 'looked fine' but that they should
>visit the feeding specialist at the cranial/facial disorders clinic at
>one of the children's hospitals.  Referral was given.


What was the reason for this?

>No suck
>assessment was done, SNS not mentioned, no mention of the difference
>between pumping with a hospital grade pump versus the PY that the mom
>already had.  Mom was sent home with instructions to
>feed/pump/suppplement on a three hour schedule around the clock b/c more
>frequent feeding would be wasting calories that this baby needed.


Well, there are a lot of ways to "skin this cat," as they say. Every three
hours around the clock indefinitely can really tire a mom...that's for
sure.  There is obviously something going on, but I don't know what. Had
the baby been evaluated for heart problems? These can cause poor gain, as
can infections. UTIs. Etc. This mom def. needed the best pump...and a
feeding tube.



>It was several weeks after this, that a mutual friend put us in
>contact.   I met with the mom, who made it clear that she would do
>*anything* to breastfeed this baby, that formula and bottles weren't at
>all in her plans for mothering and that changes needed to be made.  She
>also made it clear that the pumping was no productive and very very
>stressful.  She didn't feel she could do it any longer.


What pump did she have?

>  Another friend
>of ours gave her an SNS, which she's been using.  She also immediately
>started MMP and Goat's Rue tinctures. Noting breast size changes and an
>increase in supply very quickly.  With it,  plugged ducts reappeared.


Has she been tested for a bacterial infection of the breast? I would do this.


>Baby was fine with the SNS.  Mom loved it over bottles.  Domperidone was
>on order.    Baby gained very quickly....essentially 'caught up'.  She
>stopped using the SNS at night.  Slowly, she cut the formula back from 4
>oz every 3h to 2.5oz as needed.     things seemed to be going well.
>
>Then baby again began to fuss during the night, but was happy if she
>used the SNS......then he began drinking more formula during the day.
>The domperidone arrived two days ago - she's started it.
>
>Two days ago, she also went to the feeding specialist who said:  " latch
>and palate are fine....his palate is high, but not high enough to
>explain the problems that are present.  He nurses actively, then seems
>to stop to breathe"


Most babies do this.

>  she went on to explain to the mom how babies have
>to organize their suck and breathing. then "you'll have to pump your
>breastmilk, then feed it to him from a bottle.  Because the bottle is
>further away from his nose, he'll be able to breathe better".


I have never heard this. I wonder what her reasoning was.


>Wow.  Winning statement.   Mom, not missing a beat says "he's nursing
>now and my breast is nowhere near his nose.   I thought that if a baby
>was being held properly, then the chin was pressed into the breast
>tissue and their nose was free and clear?"  (she just got done reading
>Jack's book that I loaned her).  the specialist ignored her and went on
>to say that a referral to an ENT was in order to find out why he can't
>organize his breathing/sucking/ swallowing. She also asked if he seemed
>to snort and snore?  Mom replied that he does.


Has he been checked for a submucosal cleft palate?  The Japanese literature
suggests that hidden respiratory issues often underlie feeding problems,
...Barbara Wilson Clay has mentioned this before.

>    Specialist also felt that it was problematic that baby
>was in the 75%ile for height and only the 25th for weight and that mom
>needed to 'fatten him up a bit' by making sure that he finished at least
>four ounces of formula every three hours.


Stating that he is in the 25th percentile for weight is not a problem, per
se. It is what he is doing on the curve that matters. What the change is
from week to week. Remaining on your curve is the critical factor here. Not
whether you are in the 10th% or whatever.

>   Mom tried that for two
>feedings and it felt all wrong.  He didn't want it.   He kept turning
>his head away and fussing.  She's back to supplementing formula per his
>cues (all at the breast)
>
>Okay folks.   Any and all theories are welcome.  Mom isn't the least bit
>interested pursuing another specialty consult.  Baby is extremely happy,
>meeting developmental milestones.


Is the milk supply increasing on Domperidone? Is the mother pregnant per
chance? Just thinking... Is she a person with hormonal issues such as
thyroid problems?

>Mom did have a biopsy done in the
>upper right quadrant of her right breast for a suspiscious tumor several
>years ago.   Some of the plugged ducts were in that area, but they've
>also been in other places on that breast and on the other breast.  No
>other breast surgeries.
>
>What's going on?   Something that really warrants further consults with
>specialists?  Something that the baby will outgrow?   I keep thinking
>back to another friend who's baby was mis dx'ed wtih Pierre-Robin
>syndrome.  She just had an exceptionally recessed jaw that made it very
>difficult to nurse, paired with a mom who's supply is "just" enough
>under the best of circumstances.  The combination wasn't a good one.
>Baby didn't nurse well with the SNS.  Mom was able to supplement formula
>via bottle, while nursing often - ending formula supplements at around
>five months and continuing breastfeeding.


Some professionals believe that if the supply is not built in the first two
weeks or so, that the window disappears and so does the possibility of
building full milk supply. This could have happened as the moms struggled
with poor latch.

By the way, I never do suck assessment. Wouldn't know how. I do latch
assessment.....very crucial.


>To me, it would seem that a primary supply issue (IGT) on mom's part is
>ruled out b/c even though he was unhappy, he was gaining well enough
>during those first six weeks.   Thoughts?  Theories?
>
>katherine in atl
>
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