Great case history, Marie! I have had a number a babies like this, and they do "outgrow" the arching and fussing, but you are right, many moms never make it that long. I too have had best success just lying these kids on the bed and having mom drop her nipple into the baby's mouth, with min. handling/stimulus. Another helpful Modality is chiropractic/craniosacral for baby, if the parents are open to it...........Martha Johnson RN, IBCLC (Eugene, OR) > ---------- > From: Marie Davis, Rn, Clc[SMTP:[log in to unmask]] > Sent: Wednesday, October 14, 1998 7:58 PM > Subject: Surprizing outcome > > This was one of the most difficult cases I have worked with in a long > time. > After the problems I've had with unsupportive staff and last week I had a > big > scare with suspected new problems in my leg (which BTW is OK after all), > this > one was the highlight of my year! I have her permission to post her case. > She asked only that I protect her identity, so I will call her Anna. At 7 > days of age, she came to me because her baby had never latched on since > birth. > Anna is a 31 year old first time mom with fertility problems, this will > most > likely be her only biological child. Anna had to be delivered by C-section > 8 > weeks early because of high blood pressure and HELLP Syndrome. Baby girl, > Carla was 4 and 1/2 pounds. She was discharged from the Special Care > Nursery > at 5 days of age, bottle feeding. > In every way Carla was a healthy premature newborn who just refused to > nurse. > Normal suckling assessment, good wave motion, cupping, normal palate > shape > except that the rooting reflex was dulled. > I was unable to latch her on for more than a few seconds without baby > becoming > visibly upset. > By this time mom had very little milk, she was pumping 10 to 15 cc every > 2 > hours, with a small ev**f*o pump. At our first visit the goal was to bring > her > supply up, decrease mom's stress level about the lack of latch on and to > try > again in 2 days. She started Fenugreek and a hospital grade double > electric > pump. > I saw her twice a week for the next few weeks. She was very hyper tonic. > She > arched, pushed the breast away with her fists and screamed after only a > few > minutes of trying, didn't cuddle, turned her whole body away from mom when > held. Her back was arched constantly only her head and bottom touched > mom's > arm or on the exam table. If laid down she would immediately flip to the > right > side and hold herself in a tight fetal position, fists clenched so tight > they > turned blue. I was beginning to have concerns that the baby was > autistic, > had a brain injury or CP. She was also extremely difficult to bottle > feed, > taking nearly an hour to finish a feeding of 45 to 60 cc . > Anna confessed that she often worried that Carla hated her. I assured mom > that Carla's behavior was not directed at her, but most likely the result > of > an immature nervous system and all we could do is wait and see. A referral > was > sent to the PT/OT department to assist with the muscle tone. I told Anna > not > to worry, pump and keep trying to encourage Carla to latch on, but not to > push. > I also warned her that Carla might never latch on but I would be there for > help and support for whatever she wanted to do. Anna told me she had 12 > weeks > of maternity leave and she would continue to pump her milk for at least > that > long. Still, each time she came for an appointment I was surprised to see > her. Most of the moms I've met with this type of problem give up within a > week > or two. > Anna was doing lots of skin to skin, co- bathing, sleeping with Carla and > attempting latch on if Carla showed any interest. Saturday morning, the > day > she turned 6 weeks old, Carla began rooting toward the breast, so mom > leaned > over and viola Carla latched on and nursed for over an hour! She's been > nursing like a champ ever since. Her muscle tone is still hyper tonic. > Mom > lays her on a pillow and leans her breast over for latch on and touches > her as > little as possible while she nurses. > Mom thanked me profusely but I had to tell I didn't do anything. And I > really > didn't--Carla got too distressed too quickly every time we tried to latch > her > on. I never stress baby or mom because I firmly believe it is counter > productive for both of them. I quickly back off at first sign that it is > too > much for the baby to handle. Anna DID IT ALL by herself, every two hours > around the clock for the past 6 weeks; pumping and bottle feeding an > obviously > unhappy baby. She learned how to best comfort Carla on her own. Babies > like > her are often very hard to fall in love with (I know I had one myself). > The > way she stroked and cared for that baby was wonderful to see. I was > constantly > amazed by how well she was handling the situation. > Once again a courageous mom has taught me a great deal. I am now > convinced > that in this case and cases like this, that the key is a calm mother, who > does > not FORCE her baby to take the breast. I see a lot of moms who are > pushing a > baby to the breast despite baby's objections. Some have come into the > office > and reported that they were trying to latch the baby on for hours at a > time. > As if you can make them breastfeed by sheer will alone. Anna took my > advice > literally--try: but never push, watch the baby's signals. And it worked. > > Marie Davis, RN, IBCLC >