I have a client who needs your help (I have permission to post)!

When I met her, her baby was 6 weeks old. She had been speaking with a LLLL by phone and had been managing what appeared to be oversupply by bf'ing one side per several feedings. This seemed to work well initially, but then the mom was concerned that the baby seemed frustrated, perhaps hungry and was pulling on and off the breast and crying. Mom expressed concern that the baby never seem comforted at the breast. The LLL referred her to me, b/c it seemed that the mom needed more help than a phone consult and the LLLL didn't live nearby.

Other pertinent info:
The baby screams in her car seat
Baby had been given bottles on a couple of occassions and reported that the baby had taken the bottle
Baby has gained weight rapidly--approx one ounce per day
Mom was induced, had an epidural, meconium staining was present when membranes ruptured
Baby was deep suctioned and very sleepy when returned to mom
Mom thought difficulties had begun at about 3 weeks, but the hospital-based LC had given her the phone number of a chiropractor, as had the LLLL

When I first observed the baby at the breast, she clearly exhibited behaviour indicative of OAMER, although mom's supply was definately reduced from the prior management and was reported by mom to be less overwhelming for baby than it had been.
The baby would latch deeply and then quickly move down to the nipple; she would even pull on and off and have a difficult time establishing an organized suckle. Once she latched well, she would suckle for 3 or 4 minutes and then either stop, pull off or move to the nipple. She had a difficult time creating a good seal.

We tried a variety of positions to see if the baby was more confortable in any particular position. When mom bf the baby lying on her back with the baby across her chest, the baby's whole face relaxed and she latched beautifully and stayed on with breast compression for a good feeding.

In close observation of the baby, it appeared to me that she was physically uncomfortable in the usual positions and could not seem to establish a good latch. Her chin receded and her top lip was sucked in. Her tongue did come forward past the gum, but did not cup well. I also referred mom to the chiropractor. It is my opinion that the OAMER/oversupply was caused by the poor latch and suckle, not the other way around, although the OAMER certainly reinforced the defensive feeding behaviour. Mom also decided to avoid all cow milk products, as she was eating it at most every meal and it seemed a possible culprit.

I met the mom at the chiropractor (who also does CST) so that we could see if she would lacth better after an adjustment. Unfortunately, the baby had a cold by then and was so congested that she had a hard time nursing at all. The chiropractor found that the baby had a mild torticollis and that she was very uncomfortable turning her head ot the right. The parents reported that she rarely turned to the right and that her nose was squashed at delivery. She also had restricted movement in her lower jaw and her tongue was restricted at the hyoid. The doc gave the parents techniques they could use and saw the baby once more.

Once the baby's cold was better , she was nursing much better. Mom felt that things were finally going in the right direction. She reported that the baby was now happy and content.

Then, at 8 1/2 weeks, she called me and said "it seems the baby has forgotten how to nurse". The baby had reverted to all of her old behaviour. The other notable thing is that the baby had begun during the week or so prior to that to skip bowel movements. She seemed somewhat uncomfortable, but not miserable. Mom said that nothing had changed in her diet, the family's routine, etc. What had happened was that baby had a hepB vaccine at 6 weeks and DPT at 8 weeks. The change in bms followed the 6 week appt; the disorganized suckle followed the 8 week appt (after which mom reports that the baby screamed for several hours).

She made another appointment with the chiropractor  and the next morning the baby had a very large bowel movement and began to bf well again. The next day, all was still well, but again no bm's. Another day later and the baby was again uncomfortable and not nursing well. After another appt, the baby had another large bm and again felt better. The chiropractor referred her to a homeopath. Mom also tried co-bathing. Mom is pumping if the baby obviously doesn't feed well, as she wants to protect her supply.

I just spoke with mom tonight and she is terribly frustrated. The baby is fussy and crying and difficult to comfort. She tried to make an appt with the homeopath, but she is not taking new patients, so she will need to try another. I do not know exactly where to go next. Perhaps there is another food culprit to consider. I am going to see her again in the next couple of days.

Has anyone had a client whose baby had adverse reactions to the above-mentioned vaccines? Another LC told me that this was not the first she had heard of such a reaction to the hepB vaccine. Any other thoughts would be much appreciated. This mom is so committed to bf'ing and to her baby, but she has yet to really enjoy her baby.
Jennifer Tow, IBCLC, CT, USA

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