I will be thankful for help and suggestions for a baby I am working with.

1 mo old baby girl born via a planned cesarean 2 weeks before due date, 2470 gr. Baby was found to be 35-36 weeks gestation and not 38 as previously thought, was immature, had trouble breathing and was brought to the NICU. Spend there 17 days, because she developed pneumothorax and pneumonia on day 4. Discharged on day 17, weighing 2500 gr. The nurses reported that "baby feeds beautifully on the bottle". No direct bf prior to discharge.

Mom tried baby on the breast once at home, but baby's suck was "too strong", causing nipple distortion and severe pain. Mom has quite a lot of problems herself - she has Hashimoto's, was never able to achieve more than 100 ml of breastmilk per 24 hours despite pumping both breasts at each session 6-7 times a day (with Medela Harmony and manual Avent Isis pumps - that's what's available here, the best one can get is a Medela Swing, no hospital grade pumps in my country). But these are issues we will be dealing with and it is not what concerns me right now.

We corrected the positioning and attachment and baby sucked beautifully, without causing pain and without distorting the nipple, so that's really encouraging. But - this baby cannot feed on the bottle! I don't know how the nurses in the NICU fed her so beautifully, but what I saw and what mom and grandma reported was very different. Mom has a good position, baby vertically, encourages baby to take the bottle etc. The baby creates a powerful vacuum on the bottle, her lips are very tight and get almost white. And the suck is so strong that she cannot draw milk from the bottle. Mom tried different bottles and teats to no avail - it is a bit better with the Avent bottle, perhaps because of the teat being a bit harder than the others. With softer teats it is almost impossible to feed her. 

So mom is always pulling the teat from her mouth, which requires strenght to break the sucktion! - so baby can get a suck of milk and then again and again. A feeding is about an hour long, all struggle. Baby gets very tired, chokes on the teat and is experiencing a great discomfort. And worse - she cannot consume the amount she needs. Weight gain was only 100 gr for the last week despite the premature formula she is on (I am sure she burns almost all calories with this struggling to feed and wonder if her breathing problems are not entirely gone too). The baby's doctor said she is not consuming enough milk (8 x 60 ml is the best they had achieved until now) and that she needs about 90 ml per feeding. Mom and grandma tried very hard to give her more milk, but baby vomits if they can get 80 ml into her. We discussed feeding her more often because of the smaller quantities she can get at one feeding, although her doctor is against feeding more often than every 3 hours when baby is on formula.

I was able to feed the baby with the bottle, but the feeding required a constant moving of the teat in her mouth and teasing her palate which is not normal, I think. So I am really needing an advice on how to help feed this baby with a bottle! I find it very interesting that she can suck quite well on the breast (and what a pity that mom has supply problems!), but not on the bottle. So I think that baby has no real problems when she can feed physiologically and it is the bottlefeeding that causes her problems. I thought supplementing at the breast would be a good idea in this situation, but mom is reluctant to try and finds it stressing and awkward.

So I am open to ideas on how to help feed this baby while mom works on her medical issues and supply problems. I would be very grateful for suggestions and explanations on what could be the problem and how to deal with it.

TIA,

Christina Yaneva
BF Peer Councellor
Bulgaria

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