Sorry to combine but in a rush!

Re: Choking while using Calma teat
Jennifer, I'm really not sure whether you are serious or being sarcastic
when you write, "According to the advertisements, baby is supposed to be
able to control the flow." If you are being serious, please know that there
are NO guidelines for advertising claims on feeding-bottle teat packaging or
related info, and there are NO standards when it comes to bottle teat flow
rates! Anyone can put anything they choose on these advertisements! For
instance, the term "slow flow" means absolutely nothing -- slow flow as
compared to what? When an SLP-IBCLC colleague and I tested a number of
feeding-bottle teats all labeled as "slow flow" via a breast pump and under
comparable conditions of newborn suction, as measured by mmHg, we found a
variation of from transfer of about 5 ml/min to almost 20 ml/min -- yet ALL
were labeled "slow flow"! Medela's advertising for the Calma includes a
number of claims (
http://www.medela.com/IW/en/breastfeeding/products/breastmilk-feeding/calma-feeding-device.html),
but provides no research citations to back them up (
http://justwestofcrunchy.com/2011/02/12/medela-calma-nipple-marketing-that-undermines-moms/
).

It's basically the hole in any teat that determines the size of the bolus
coming through it. Many/most teats take very little oral suction or
compression (e.g. Haberman) for passage of a bolus. Many/most full-term
babies can quickly develop (mal)adaptive oral behaviors to handle a larger
bolus, but they do so at the expense of normal physiological suck(l)ing
behaviors. There is a reason bottle-feeding is associated with greater use
of different oral muscles and why bottle-fed babies are at greater risk for
dentition issues.  If baby can't handle the bolus, baby is telling everyone
something -- "This isn't working for me!" Whether it isn't working because
baby has an underlying physiological issue, the bolus amount is ridiculously
large for baby's level of maturity, etc, it doesn't matter. It isn't working
for this baby

I don't remember whether this baby was full term or how much laid-back
breastfeeding has been tried. Also don't remember if there was any deviation
noted in baby's oral space. I think a thin silicone nipple shield may be
worth trying if the right size and applied correctly (and probably used with
laid-back breastfeeding positioning). I do that know one can't believe what
one reads on packaging or related ads. Hope no one falls for such hype...
but I know people do based on some of the info mothers tell me they received
from health professionals, including LCs re: rationale for bottle teat
purchases.

With all respect,

Karen G


Date:    Tue, 30 Aug 2011 13:16:44 -0400
> From:    Jennifer Welch <[log in to unmask]>
> Subject: Choking while using Calma teat
>
> Hello wise ones,
>
> Permission to post.
>
> Some of you may remember my post about the lethargic baby I saw two weeks=
>  ago.
>
> (brief backstory - saw bb at 8 days, >200 g loss since discharge, signs o=
> f dehydration, lethargic, mom unable to pump milk at first so we began fo=
> rmula supplementation using tube on finger pushed by syringe, then on bre=
> ast pushed by syringe.  Fast forward 2 weeks, baby now 3 wks old, now exc=
> lusively breastmilk fed, though most not at the breast because bb cannot =
> seem to suckle well, latch has been worked on, after 1st exam, I though n=
> o TT, it seemed very clear to me, but I will check again when I see her i=
> n a few days.  Bb was seen at a walk-in to rule out other problems, is no=
> w gaining well)
>
> Mom has begun using the Medela Calma teat, she found the alternative meth=
> ods too taxing.  She reports to me that bb sucks well, generates suction,=
>  but chokes on the flow.  This surprised me, though I have virtually no e=
> xperience with this teat.  Has anyone else had a baby choke on the flow w=
> ith a calma teat?  According to the advertisements, baby is supposed to b=
> e able to control the flow.  What could be going on here?
>
> I am wondering about that condition where you hear the squeeking and chok=
> ing, but i cannot remember the name, or how to detect it.  (any info much=
>  appreciated!).
>
> I am thinking this baby is used to extra stimulation on the palate, thus =
> will not suck only on mom's nipple.
>
> We will work on latching again, and perhaps try a nipple shield.
>
> Anything else we can to to try to stimulate sucking on mom's nipple?
>
> Thanks!
>
> Jennifer Welch, IBCLC, LLL
> Montreal, QC Canada
>
>             ***********************************************
>


Re: prolactin levels and surge
What makes this mom/you think milk production is low? How often is baby
effectively breastfeeding and/or is milk (really) removed thoroughly via
some other means in a typical 24-hour period? (How does this compare with
BF/milk expression per 24 hours during the early days to weeks?) Did mom go
into shock with the PPH? What's her H&H like now?

Determining whether a prolactin and surge level might be useful requires
more info re: basic management of BF/lactation for this mom...

KKG




> Date:    Tue, 30 Aug 2011 13:50:50 -0400
> From:    jerri walker <[log in to unmask]>
> Subject: prolactin levels and surge
>
>
> A question for you wise women... I don't post often, but do lurk very
> often!
>
> I have a patient 3 months PP who is struggling with milk supply.  It is her
> first baby. She is currently taking domperidone. We did a prolactin level
> and surge, although, I believe the surge level was not at the full
> 45 minutes. Her prolactin level is more than adequate at above 200ng/ml. The
> rise for the surge was minimal, about 20 ng/nl. She also had a post partum
> hemorrage with a hgb at 8.5. Normal PP course otherwise and appropriate
> involution of the uterus.  She also has a wide space between her breasts and
> average size breasts that are more long than rounded.
>
> Is it worth doing another prolactin and surge level with the appropriate
> time interval? Since she is already taking Domperidone, I am not sure of the
> next step. I did offer U/S to evaluate for retained products, although, I
> doubt this is an issue.
>
> Jerri Walker, CNM, MSN, IBCLC
> Back Cove Midwives
> Portland, ME
> [log in to unmask]
>
>             ***********************************************
>



Re: Starting solids /sacrificing sleep
I'm with Rachel Myr - this seems more about connecting with Mother as home
base than it is about needing more solids (which could compromise milk
production). I'm trying to figure out how the mom is breastfeeding on demand
yet baby is in day care, which implies mother-baby separation for some
amount of time. That would be a huge change for a baby. And many babies have
difficulty BF as effectively during a cold or they BF differently during
mild illnesses, so that while the number of BFs may have somewhat increased
the amount transferred may have dipped a bit with a transient dip in
production. (Grazing can be an important way for production to bounce back.)
Both a change in caregiving and a recent illness could easily explain
nighttime grazing. So could an incoming tooth, the "practice" of a new
physical skill when in light sleep, etc., which might cause baby to wake
more easily from light sleep.

KKG



> Date:    Tue, 30 Aug 2011 12:10:04 -0700
> From:    Todd & Rita Madden <[log in to unmask]>
> Subject: Starting solids / sacrificing sleep
>
>
> Hello all I am hoping to glean from the vast and wonderful knowledge of
> this list A mom and baby couplet have been exclusively nursing for 6 months.
> At 6 months, mom started solids for a week, baby got a cold, stopped solids
> until cold cleared (1 week) and is now back to solids once a day along with
> continued nursing for the past 2 weeks. This puts baby at 7 months old.
> Mom's complaint is that baby is waking twice at night to "graze" and has
> never done that before. He has been doing that for the past 3 nights. My
> first thought is that he may have a residual ear infection from the cold,
> but mom says he doesn't act out of sorts during the day. My second thought
> is perhaps there has been a change in his routine. The only change was
> starting a new day care 3 weeks ago. Mom's thought is he is not getting
> enough, yet her supply is great (has 200 ounces frozen still). She nurses on
> demand and she gives him one "ice cube" size portion of her homemade
> vegetable baby food once a day. I encouraged her to increase the amount by
> offering it 3 times a day during their meal times. Is there anything else I
> can tell her? Rita RN IBCLC in Iowa
>
>





-- 
Karen Gromada
www.karengromada.com/
http://www.marchforbabies.org/karengromada

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