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Subject:
From:
"Catherine Watson Genna, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 5 Apr 2005 23:59:25 -0400
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How much is he gaining?  If it's more than about 2 lb a month, there 
might be oversupply/overfeeding happening.
What were the results of pre/post feed weights?  This is the sort of 
situation where this information is invaluable.  This would allow you to 
figure out whether the baby seems miserable as the flow increases or as 
it decreases.
Is the nasal congestion present all the time, or does it increase as the 
feeding progresses?  The latter is a sign of microaspiration occuring, 
and would be a sign that the baby is not coordinating swallowing and 
breathing well.  One common reason for difficulty coordinating 
swallowing and breathing is tongue tie, another is laryngomalacia or 
tracheomalacia. Constant congestion is more likely to be associated with 
allergy.
A physician friend feels that swallowing issues resulting from tongue 
tie might possibly set up a dysrhythmicity along the entire digestive 
tract, increasing the risk of reflux and other gi issues. There is at 
least one case report of reflux in an adult resolving after lingual 
frenulum release.

Some suggestions:
Allow baby to feed until he seems fussy, then end the feeding and 
comfort the baby.  When he makes any feeding cues, allow him to feed 
again. If he feeds frequently, let him use one breast several times 
before switching (once he learns to take the other breast).
Make sure mom does not hold baby's head at the breast, let him feel in 
control so he can let go whenever he wants. Mom can support his shoulders.
Try prone positioning (mom reclining, baby laying on mom's chest) to 
help baby have a microsecond longer to handle a bolus of milk for 
swallowing.
Give the elimination diet a week or so to work, usually there is marked 
improvement within a few days of eliminating something baby is allergic to.

In very severe cases of allergy that can't be traced to something mom is 
eating, elemental formula for a week or so can sometimes allow the gut 
to heal and baby to go back to breastfeeding. This would be my last 
resort personally, but has worked for several of my clients.
Catherine Watson Genna, IBCLC  NYC

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