A mother I have been working with has asked me to post this case. Though at 6 mos. this baby no longer breastfeeds, she takes exclusively EBM by bottle. We were wondering if anyone has seen a case like this in their practice Baby girl born full term weighing 7 lbs. 2 oz. Weight at discharge was 6 lbs. 10oz. Baby regained birth weight by sometime early the second week and was 7 lbs. 6 oz. by day 13. Mom reports that baby nursed at the breast well for the first two weeks, averaging 10-15 mins. per side every 2-3 hrs. At around 2 weeks postpartum, mom developed burning of nipple and breast and was prescribed all purpose nipple ointment by a breastfeeding-knowledgeable MD. It may be coincidental, but around that time, baby began nursing on only one breast per feeding and nursed for shorter durations. At about 4 weeks, baby commenced a course of Nystatin, but began having vomiting episodes, so med was discontinued. At the same time, mom started a 28-day course of Diflucan. I was consulted during week 5 because baby had lost 2 oz. since the end of week 2. At visit, baby’s latch was shallow and her sucking motion seemed non-nutritive, with infrequent audible swallowing. Digital assessment revealed a high palate with some tongue bunching, but no tongue-tie. I believed that baby had not been sucking properly since birth, but gained sufficiently at first by passive means due to great milk supply. Mom was instructed in latch techniques and sucking exercises to encourage baby to open wide and keep tongue down. I recommended continuing work on latch/suck with supplementation by finger-feeding as necessary. Mom pumped to keep supply up while baby’s nursings were erratic. At 7 weeks, a pre- and post-feed weigh showed that baby got 1 ¾ oz. after 6 minutes at the breast. Time at and interest in the breast fluctuated and mom supplemented more w/EBM in bottles, finding alternative methods unworkable. By about 2 ½ months, baby started showing less interest in the bottle as well and gained only 3 oz./wk. between then and 4 mos. During this time, daily intake of EBM by bottle was 19-21 oz/day. A pacifier was introduced at month 4. At 4 mos. baby started Mylanta, 1 tsp. 2x/day, which was recommended by ped because of fussiness, arching and crying during attempts to bottle-feed. Daily feeding volumes increased to 21-24 oz from month 4-5 and then decreased early in month 5. It was becoming a struggle to get the baby to take even bottle-feedings. Mother has tried different nipples, different feeding positions, etc., to no avail. She is currently using the medium-sized Avent nipple. Between 4 mos. and 5 mos., baby continued to show less interest in the bottle, would breastfeed occasionally and only gained a few ounces. At the end of the month 4, baby started a 14-day course of diflucan which was prescribed by the ped over the phone based upon mother's report of a white tongue. At about 5 mos., mom started fortifying her EBM with cream skimmed from settled EBM. At that time, baby had blood work and urinalysis done which was negative for infection or abnormal thyroid. The baby was referred to a nutritionist at 5 ½ mos. who recommended mom fortify her EBM with formula (8.5g of Similac w/iron powder to 10 oz. EBM) to help baby gain weight. During month 5, mom introduced rice cereal and bananas, which baby had little interest in. Baby had some very loose stools this past month. Otherwise, stooling has been adequate. In the last two weeks, (between 5 ½ and 6 mos.), daily milk intake has been decreasing to < 18 oz./day. Baby will generally only take the bottle when in a near-sleep state. Baby has gained no weight this month and is currently about 10 lbs. 15 oz. During the last few days, daily intake has decreased to 12-13 oz. of fortified EBM. Baby spits bottle out or pushes it away with hands after she has taken only an ounce or so. Baby's diapers are less wet. Baby was seen by a ped GI doctor last week who did a 24-hr. pH wire test for GERD (negative) and ruled out celiac disease. An endoscopy is planned and the baby has an appointment in mid-March at a suck-swallow clinic. No evaluation yet for heart problems. Otherwise, baby is generally a happy, alert, "easy" baby who has achieved all developmental milestones. The GI doctor has said that if feeds drop off any more, it may be necessary to insert a feeding tube while testing for a feeding disorder proceeds. This mother has managed to maintain a great milk supply (pumps more than 35 oz./day). She is desparate and feels that the baby is now on the borderline of taking enough for hydration. If any has had any experiences with babies like this, please reply. Thanks in advance, Ellen Maughan, JD, IBCLC, LLL Leader ________________________________________________________________ Sign Up for Juno Platinum Internet Access Today Only $9.95 per month! 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