I am working with a client whose baby was induced early and weighed 5# 10oz
at birth.  He gained well for the first 4 weeks. Then mom got too busy
(waaay too busy) and baby stopped gaining (possibly even lost some), was
feeding for up to an hour when he had his infrequent feedings. They were
using a pacifier when he was "fussy." Then the crisis came Friday the 25 of
may. He weighed in at 6# 9oz and didn't look good.

Ped recommended pumping, feeding with bottle only for 48 hours, feeding 4
ounces every 3 hours and if there wasn't enough breastmilk to add formula
to make up the 4 ounces. Mom didn't want to give formula so she began to
pump often. She began with getting 1 1/2 ounces at a time and was using
stored milk for up to 3 ounces.  Baby was satisfied with 3 and was spitting
up after the 4 oz feedings.  He was bottle fed for the prescribed 48 hours.

Yesterday, 4 days after the problem was discovered he weighed 7#8 oz.

By Monday with More Milk and frequent pumping she was getting 3 ounces in
20+ minutes of pumping. When she resumed breastfeeding his suck was weak
and he was using the breast for comfort, falling asleep after the first
MER. So she kept pumping after feeding. His eyes are closed while at the
breast but with any other methods he stays alert.

They have the BabyWeigh scale and he is taking 1 ounce at the breast,
falling asleep after the first MER and just hanging out. She is using the
SNS for supplementing with breastmilk. With finger feeding with the SNS he
feeds vigorously and gets the rest of his milk and is satisfied, but at the
breast he is still weak even with the supplementer. She has to squeeze the
flask to keep him drinking.

Dad was insisting on a bottle for the nights so they are using the
Haberman, alternating the mid and short-line. When the flow is cut off in
the short position he suckles strongly, then dad turns it to the mid line.
He does this throughout the feeding, stretching the feed to at least 20
minutes.

What are your suggestions for strengthening his suckle at the breast? How
can we help him to know that vigorous suckling at the breast is the place
to do it. Will the use of the supplementer at the breast keep him
inefficient in his suckle?  Will the present pattern allow him to comfort
suck and sleep at the breast while he waits for the "real" feeding with
finger or Haberman?  Will keeping all of his feedings at the breast show
him, in time, that breast is where it happens and vigorous suckling pays off?

He definitely has a memory of breast as comfort even if there wasn't much
milk, but how to change that pattern? He doesn't remember about initiating
another MER.

I'm hoping that you Wise Ones out there have some thoughts and ideas on
this case.

Pat Gima, IBCLC
Milwaukee, Wisconsin
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