Hi Andrea,
Have you ruled out hyperlactation?  Perhaps leaning mom backward in a reclining position can put him in a more comfortable "power position" on top of her.  If mom is only pumping and bottle feeding after breastfeeding 3 kids for 2 years each, I'm guessing she is making a ton of low-fat milk.  Gagging at the breast is a clue.  How is his weight gain now?  At 12 weeks, this may be more difficult, but not impossible to resolve.
Annie Brown, FNP, IBCLC
Greenwich CT

On Mar 8, 2010, at 5:23 PM, LACTNET automatic digest system wrote:

> I am out of ideas and would love to know if any of you have had anything that brought success with persistent breast refusal. Mom has asked me to pass her situation around for ideas.
> 
> This is Moms' fourth child and she breastfed the others for 2 years each. Spontaneous vaginal delivery at 40 weeks. Baby admitted to NICU for pneumonia and was exclusively breastfeeding until Day 6 when it was advised to give a bottle because of ineffective feeding. Mom's perception was the baby was breastfeeding fine until that point. Gave the bottles while in hospital and then tried just breastfeeding at home but baby didn't suck strongly enough and doctor advised continued bottles because of inadequate weight gain. Mom tried before seeing me: SNS, nipple shield, skin to skin and co-bathing. She said "everything works for a little bit" - he'll take the breast for a feeding, and then refuse again and then the thing she tried won't work the next time.
> 
> I saw her at 7 ½ weeks and infant was alert and had a normal suck and would not latch to the breast. We tried a nipple shield with dripping milk on the shield, we tried back and forth with the bottle. He displayed classic breast aversion behavior, arching and fussing as soon as she positioned him at the breast.
> 
> I recommended a one week break from offering the breast but with skin to skin. I also recommended eliminating wheat because she already doesn't do dairy and there is a family history of wheat intolerance.
> 
> After the week off he did latch a few times but not consistent. We played phone tag for about 3 weeks and today she told me he has been refusing most of the time. She felt like he had days where he just didn't feel good so she had him evaluated for food allergies by a homeopath who told her he was intolerant to wheat. She has been off wheat for two weeks and he just got over a cold. She has also had a couple craniosacral sessions and is going to have another, but the CS therapist didn't find a lot going on. Mom also said he is gagging at the breast more often. She uses a Dr, Brown's premie nipple system.
> 
> I have recommended a day in bed, offering the breast frequently. My feeling is we just haven't figured out why he's refusing. If anyone has any other thoughts or suggestions I would be grateful to hear them.
> 
> Andrea Tran RN, IBCLC
> Boulder/Erie, Colorado

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