Re: update on troubling client

[Guest guest]

I am wondering if there is any chance this baby has an underlying infection r/t the amniotic sac being gone for so long. Guess I am starting to look at zebra's a little more.

Donna

Update on Troubling Client

Last night I poured over resource books. This morning I called to check on this nursing couple and reschedule our appointment as my elderly aunt that I help care for was having a psychotic episode (really). Baby was now refusing all bottles and still not nursing at the breast. In the past 18 hours he took in approximately 7 ounces. I've had them call their pedi to see if he wants to see them before I do again.

Keep your observations rolling in!

Dawn

[Guest guest]

The same thought has been bugging me since reading this case. Has the baby seen his Ped ?

Keep us posted.

Ghislaine Reid

Update on Troubling Client

Last night I poured over resource books. This morning I called to check on this nursing couple and reschedule our appointment as my elderly aunt that I help care for was having a psychotic episode (really). Baby was now refusing all bottles and still not nursing at the breast. In the past 18 hours he took in approximately 7 ounces. I've had them call their pedi to see if he wants to see them before I do again.

Keep your observations rolling in!

Dawn

[Guest guest]

I’ve had my own issues occupying my

attention lately so have just read through all the posts on this couplet.

I would also suspect GERD. That would explain baby’s problem with

both bottle and breast. Also sore nipples, as baby does some oral

gymnastics to cope with this unpleasant problem while feeding. That would

also account for spitting up a while after the feed, unlike overfeeding where

spitting up would occur very quickly after the end of the feed. I have

moms feed only on one side at a time to limit the quantity (I realize at this

point, the problem isn’t “limiting” for this baby but getting

more in!) and see the pedi asap. Shorter feeds more often usually benefit

this baby. Medications help tremendously. I currently have a couplet

with this issue. Baby is now almost 3 months and has settled considerably

with the introduction of a med (Zantac.) What I have seen with this

condition are symptoms that make no sense, such as you describe. You just

don’t see a clear reason why there is a problem. Hope this helps.

Good luck!

Marsha

~~~~~~~~~~~~~~~~~Marsha Glass RN, BSN,

IBCLC~~~~~~~~~~~~~~~~~~~~~

Mothers have as powerful an influence over

the welfare of future generations as all other earthly causes combined.

~~~~~~~~~~~~~~~~~~~~~~~~~ S. C. Abbot~~~~~~~~~~~~~~~~~~~~~~~~~

[Guest guest]

Yeah! sounds like things are getting better. If she gets her supply up she will be all set as long as grandma doesn't keep forcing the bottles. Sometimes that is the most difficult thing is getting Grandma into the program while acknowledging their "wisdom" as a grandma.

update on troubling client

First, a HUGE thank you to everyone who responded. The parents are taking baby to pedi this afternoon, mostly to assess for GERD/reflux and to CST just after. Things look much improved today -- read on for more of the story. Some corrections and an update on my "troubling client".

First off, I was typing from memory rather than looking at her history. Having seen several clients in the interim I provided some misinformation.

Here's the correction:

Baby's APGARs were 6 & 9. He was only on mom's chest for about one minute when they took him to the warmer for further evaluation. In spite of the high 5 minute reading he was still bluish and breathing with retractions so he went into NICU right away, stayed for two days with IV antibiotics. Therefore, he DID NOT nurse at all until about 6 hours postpartum and then with only moderate success. After NICU they stayed another 2.5 day stay rooming together in "transition" next door to NICU.

Updates:

10/06/04 -- phone call to client to reschedule. Baby has only taken 7 ounces by bottle in past 18 hours or so with limited breastfeeding sessions. Mom getting but about 1 ounce per each 15 min pumping session (double pumping with a Symphony). Diaper count still within appropriate range. I suggest contacting pedi with this info in case they want to see baby sooner than Friday scheduled appt.

10/07/04 -- Baby was nursing when I arrived this morning. The mood in the house is noticeably more relaxed and lighter. His latch still looks to be on the shallow side, but he maintained active, alert sucking for 15-20 minutes. Mom reported no nipple soreness or pain associated with this nursing. When I weighed him after (no before weight because he awoke hungry prior to my arrival) his weight was up to 7'10" 5 tenths, almost 3 ounces over his high weight two days ago on Tuesday afternoon -- all breastmilk, no formula during this interval. He then switched to the other (less favored) breast, nursed sloppily for about 10 minutes, with us relatching him a couple of times to increase depth of latch. We figured this was such a minimal feed that there would be scant, if any intake. He transferred 7 tenths of an ounce! He is then offered a 2 oz. bottle of EBM. I redemonstrate paced feeding (now using Avent bottles -- which explains his difficulty with bottles yesterday during the transition from old style teats), mom practices then grandma is going to practice. Baby looks to me like he doesn't want the bottle anymore and he's probably pretty full -- grandma coaxes/forces the remaining contents into him. With grandma in the room (I'm unsure of the scope of her English comprehension, but I want her to hear if she will) to PLEASE let the baby decide when to end feeds when he is alert and happy (it's another story if he's been asleep for 4 hours and is having difficulty rousing). I explain that he will probably spit up LOTS in a few minutes.

I looked for a sub-mucosal cleft and didn't see anything even remotely close, but I did observe "Epstein's Pearls". I recommended bi-weekly weight checks for two weeks or the option of renting a scale. Mom will begin fenugreek and blessed thistle and continue with pumping since I believe she has a somewhat compromised supply at this point. She stopped her pain meds, still taking ibuprofen though -- advised caution around the mastitis issue with this as it could mask some of the early symptoms. Suggested keeping track of baby's temp twice per day for about a week. Mom will request "triple nipple" ointment to prevent infection from setting in.

I can't tell you how impressed I am with this mom -- she's SO wanting to do the right thing, feeling like the problems are "all my fault" and struggling with her mother who wants her to abandon breastfeeding and switch to formula. I gave her lots of positive strokes and encouragement for her efforts -- I also PROMISED her that there was more work but that things would **eventually** get easier -- so everyone please implore the IBCLC Goddess who grants such things to make this one come true!

I'll be calling daily for a few days and will post updates.

Thanks again to all of you,

Warmly,

Dawn , IBCLC, CD(DONA)

Austin, TX