Dear Friends:
    Thank you Katherine from Atlanta for a great story. What made the
difference in this case was a proactive mother, who called for help about
breastfeeding when her baby was 4 weeks old.
    I spoke at length with the infant feeding specialist today, asking "how
dysfunctional could this suck be if baby has been gaining 1 oz/day?" I didn't
get a clear answer, and the suck she described didn't look like the suck I saw
at 4 weeks. It is possible the baby has decompensated some in the interim.
    The specialist said the mother broke down in her office on 2/10, because
B was only going 5 hours at night without nursing. Specialist got her pumping
after a breastfeed, and using a bottle every other feed (with EBM) in it, and
says that it all must be working now as baby is going longer (8-9 hours)
without nursing at night.
    Specialist was concerned about compromise to milk supply from poor suck,
and didn't answer my question to my satisfaction about how poor could the suck
have been. I explained to her about prolactin receptors being set in the
first days after birth that regulate supply, and also explained that milk supply
is fairly constant, once a mother hits her production level. Specialist had
some idea that volume increased over time (like babies who take in more and more
formula), so we had a discussion about calories in liquid.
    It is wonderful to have this discussion between disciplines. I have
learned a lot. I thought that the baby was hyperextending her head to stabilize her
airway, and that should be good. Specialist explained that baby has tongue
protrusion, and hyperextending her head was a way to compensate for that.
    It is possible that I got so excited at the visit that I missed this
dysfunctional suck.  I checked my notes and have no mention of these things in my
assessment. And I still can't completely reconcile the specialist's assessment
with a baby gaining an ounce a day.
    The specialist said the baby was working so hard at breast, and taking an
hour to feed and spending too long at NNS. But how could the baby have burned
all those calories to feed, and still be gaining an ounce a day? Unless she
has nursed so frequently that the mother has a very high cream content???
    Anybody have any other ideas?
    warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE, CIMI
Maternal-Child Adjunct Faculty Union Institute and University
Film Editor, Journal of Human Lactation
Support the WHO Code and the Mother-Friendly Childbirth Initiative

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