9-1/2 week old transitioning back to breast

[Guest guest]

Hello everyone,

Saw a first-time mom yesterday; baby 9-1/2 weeks old. Last time at breast was 2

weeks old. Mom has pumped since day 3 with a Lactina, but this has dropped off

to maybe once/day, as baby is high-needs, has reflux, and mom has no support

from family other than husband. This is their choice; they say family

disagreements add to the tension, and the grandparents are elderly and not much

help. Dad is troubled by baby's crying, and it was his decision to stop trying

to offer breast as well as bottle, because baby was so upset.

Mom has been bottle-feeding expressed milk and formula, 1/3 and 2/3; maybe 600

mL/24 hrs, divided into 8-10 small feeds. Baby is also on reflux meds and

antacids. Day before yesterday they gave her 15 mL prune juice (per ped's

advice) for constipation. Baby's avg weight gain has been .89 oz from lowest

weight to present. Baby is in 15% for wt and 25% for ht. Mom's breasts are

firm, nipples are flat, med to large diameter; L somewhat bifurcated.

Baby's lingual frenulum is absent. Bubble palate. At first tongue did not lift

when she cried; i thought it was held down from below. Felt a piano string

beneath. Extension and spread good. Cupping was so-so; pulling down on baby's

chin while she latched on my finger resulted in snapback with every suck. Later

her tongue did lift--asymmetrically--at least the tip did flip up and lifted

past midlife. Mom reports that her nipples were pinched and scabbed when baby

had come on the breast those first 3 days.

I suggested craniosacral for tongue function, reflux, and fussiness. Baby took

30 mL as I got there, as she was frantic. My plan had been to lay baby STS on

mom's chest afterwards, and see what baby-led latching she might do. But first

i examined baby's oral anatomy, and mom ran to brush her teeth.

By then baby was frantic again, and it took time to calm her. Once mom got

naked from the waist up and baby in her diaper, she had a brief Ahhh!! moment

where baby just stopped crying for a second.

Eventually baby took the pacifier--though she was still crying--and quieted to

where mom slipped the bottle in. She was still holding her completely prone

STS.

I just spoke on the phone with Ann --on this list--thank you SO MUCH,

Ann! Got a list of things to look for: jaw excursions, counting sucks, facial

asymmetry, baby's self-limiting behaviors at breast, among other things. I plan

on finding out who in her insurance plan--Kaiser Los Angeles might clip a tongue

tie, and attempt a nipple shield to move more towards mother's stated goal of

exclusive breastfeeding.

I suggested power pumping, finishing at the breast and breast for comfort, STS

feeding and safe co-sleeping.

Any other thoughts, suggestions as told how to work out this transition, or what

to reasonably suggest? Thank you in advance.

~Nadja Catano, M.A., IBCLC