In a message dated 5/21/01 12:11:40 AM Eastern Daylight Time,
[log in to unmask] writes:

 Kathleen states:

" After correcting and achieving a deep latch baby nursed for
 about 15 to 20 minutes obtaining 22cc at the right then another 22cc at the
 left, we switched  and recorded another 24 cc at the right and then 26 cc at
 the left.   There was no obvious gulping, chocking, sputtering or rapid
 intake of large volumes, as I would suspect with oversupply.  I thought I had
 identified the slow gain as related to the suboptimal latch.  Additionally
 the baby had gained 1.5 ounces from the previous day since the mom had
 started to supplement.   The baby had several episodes of reguritating into
 the throat and re-swallowing it and eventually spit up about 5-10cc total.

 Today the mom tells me she is noticing the baby seems most uncomfortable and
 spits up the most when on the breast, is a little better when given bottled
 breast milk and is best when given bottles of formula.   She really does seem
 motivated to breastfeed and is understandably very upset.

 I definitely think this baby has reflux that probably needs some medical
 intervention in the way of medications but why in the world is he doing
 better with a cow's milk based formula than his own mom's milk and why the
 difference between breast and bottle when there doesn't seem to be
oversupply?"

I've seen moms who are so uptight when they are breastfeeding that they
experience few MERs and communicate their stress to their infant who remains
uncoordinated and uncomfortable throughout feed and therefore unable to
coordinate suck effectively.  This baby might not get the reward of faster
flow and be working hard to extract milk due to poor MER.  It just strikes me
when moms say "my baby does so much better with the bottle" that their
confidence is shot and they feel something is wrong with them.  This may or
may not be the case with your mom but may be worth exploring feelings with
her and trying relaxation techniques, etc.  It may only be part of the
picture but I find that stating to mom, "It must be frustrating, make you
feel bad, or the like, that your baby seems to do better with the bottle,"
and then go on to inform her that you're there to help solve the puzzle.  If
I feel mom is perhaps unsure of her desire to breastfeed a simple "How do you
feel about BF and what is your BF goal," can clarify her intent.

Just some thoughts about factors I find can be overlooked initially and
sometimes I'm late in dealing with this because I get caught up in mom's
emergency of the situation.

Barbara Latterner, BSN, RN, IBCLC
Brewster, NY

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