I just need support...please - update post #12

[Rose-Roget]

I am so frustrated right now. A week ago on Monday, dd (2 months) was dx'd with thrush after she'd stopped nursing for a few feedings. They treated with Gentian Violet and gave me Nystatin and all seemed better for most of the week.

On Wednesday, she had her 2 mo well-baby, and we discovered she's not gaining much weight (14 oz in 6 weeks - I posted about this). I called the lc at our hospital - she gave me some tips to try to beef up my supply and her calories and we scheduled an appt. for tomorrow, after I'd had time to implement some of those strategies.

On Friday, the nursing strike started again. I called the ped. who gave a prescription for oral Nystatin. I barely see any white in her mouth - just a thin layer on her tongue that doesn't wipe away easily, but that may be just enough to make her too miserable to nurse. She didn't bf at all over the weekend. I pumped and pumped, but I'm not getting a ton. We did monitor how much she's intaking with her bottle feeds over the weekend - we struggled to make it to 20 oz., which I know is low. I'm hoping that that's related to the thrush, also.

Yesterday (Monday), I got her to bf twice. This morning, she bf'd for 2 feedings, and on each side (she's avoiding the left more than the right), but then only once more on the right later in the day...and she barely touched her bottles!

I talked to the lc on the phone. She gave me suggestions to help manage the thrush and to take fenugreek. I bought a tincture of More Milk with fenugreek and others. I've also been drinking Mother's Milk tea and nettle tea throughout the weekend.

Tonight, I noticed a red line on my left breast, but I don't have any pain or lumps, so I'm hoping it's just a scratch.

I am planning to reschedule with the lc because I haven't been able to do anything to get my supply up - if anything, it's diminishing - and I couldn't even guarantee she'd bf there, so it would completely defeat the purpose.

I just feel like it all came at once and everything is spiraling out of my control! The one thing I thought I could do well for my baby evidently wasn't enough and now she doesn't even want that. I don't know what else to do.

[womenswisdom]

Breathe deeply. It's going to be okay! How many wet/dirty diapers is she having a day? If she is having enough, she is eating enough.

Are you sure that thrush is still the issue? I know both my kids always had a whitish coating on their tongues that wasn't thrush. Maybe she is uncomfortable for some other reason. Have you considered chiropractic or craniosacral?

And don't worry about your milk supply just because you aren't pumping that much - many moms who have a fantastic supply for their nursing babies are not able to pump much or at all. Also, if you do need to pump, be sure to use a hospital-grade double electric if the one you're using now is not working for you. I'm sorry you're going through this.

[PatioGardener]

Hang in there The nursing strike is not about you at all - it is baby feeling uncomfortable. Have you had her ears checked? It may be an ear infection.

You have really been through the wringer with this - and you continue to persevere! You are so strong.

[PatioGardener]

Originally Posted by womenswisdom

Breathe deeply. It's going to be okay! How many wet/dirty diapers is she having a day? If she is having enough, she is eating enough.

But baby is not gaining enough weight, so there is an issue here that her Mama is trying to deal with. Diapers are one measure of hydration and intake, but weight gain is also very important and must be taken into account. If I remember correctly this young baby has only gained 1/3 -1/2 of what you would expect from aged 2 weeks - 2 months. That is a concern.

[Rose-Roget]

Thanks for the kind words.

Yes, you remember right - she's gained only about 1/2 of the minimum amount; 14 oz in 6 weeks. She's growing longer, her head is growing, and her diaper output is good...but she's not gaining very well.

I'm using a Medela double electric Pump In Style. Typically, it's good enough, but I'm wondering if I should rent something better short-term, given the circumstances.

I did ask for her ears to be checked out - that's actually what I thought was going on when I took her in the first time last week. She seems perfectly healthy, aside from the weight gain.

Could reflux contribute to poor weight gain? She doesn't have the overt symptoms that my ds had, but she eats frequent, small meals, has a hard time burping, sometimes fusses or arches while feeding, wet burps, poor weight gain. Maybe not - I'm just trying to think of causes.

So if she doesn't start gaining, my ped will recommend formula supplements to boost calories. Is that the beginning of the end???

[womenswisdom]

Originally Posted by PatioGardener

But baby is not gaining enough weight, so there is an issue here that her Mama is trying to deal with. Diapers are one measure of hydration and intake, but weight gain is also very important and must be taken into account. If I remember correctly this young baby has only gained 1/3 -1/2 of what you would expect from aged 2 weeks - 2 months. That is a concern.

I'm sorry, you're right, I did not realize that. I would suggest, however, that you might compare your baby's weight gain to the WHO's chart of breastfed babies to be sure you really have a concern. My ped pushed so hard for my daughter to be weaned and go onto cow's milk (she was a little over a year) because based on the CDC charts, she was not gaining sufficiently. But when I compared her to other breastfed babies on the WHO charts, she was doing fine!

If you do find that you have a true weight gain concern, you might start an elimination diet to see if something you are eating is causing discomfort. Good luck, I know you will be able to work this out!

ETA: I went back and found your previous post and if I'm doing my math correctly (it's in kilograms), it looks like she is maintaining a good curve on the WHO chart. Maybe print that up and see what you think: http://www.who.int/childgrowth/stand...irls_p_0_6.pdf

8#11oz (8.68#) at birth = 3.95 kg and 9#15oz (9.94#) = 4.52kg

Looking at this curve, I would personally not be concerned about weight gain. The CDC charts are based on a population of babies that is mostly formula-fed, and breastfed babies gain at a different rate. Length and head circ. are maintaining as well, so that is also a good sign.

[jecombs]

Thrush is so tough to deal with! I just wanted to let you know that I have been there and we eventually made it through.

I am concerned about the way your HCP is treating the thrush. When I had it, my LC told me that 60% of thrush is resistant to Nystatin treatment. Nystatin can also upset baby's tummy, making them want to nurse less. Here is the protocol I followed:

1. Use Gentian Violet on my nips and baby's mouth.
2. Take max. dose of Grapefruit Seed Extract.
3. Sterilize all pacis, bottles, nipples, pump parts, AND BRAS every day. (Bras must be washed in hot water, with soap and some vinegar. Let dry in direct sun if you can). Anything that comes in contact with baby's mouth, your nips, or your milk must be sterilized.
4. Take max dose of good quality probiotic every day (I use Jarrodophilus).
5. Cut all refined flour and sugar out of my diet (yeast feeds on these things).

This is essentially Dr. Jack Newman's protocol for thrush. Here is a link.

Despite all this, we kept getting reinfected by a paci storage container they were using at daycare (they were washing it, just not sterilizing it). It took me months to figure this out. Eventually DD and I went on a 2 week course of Diflucan, which got things cleared up. We had thrush for almost 4 months. It was terrible.

Thrush is tenacious and must be treated aggressively! Your babe may not be old enough to take Diflucan yet, but you can still take it if necessary. The thrush may be in your ducts, so you will need something systemic to clear it up

[PatioGardener]

Originally Posted by womenswisdom

ETA: I went back and found your previous post and if I'm doing my math correctly (it's in kilograms), it looks like she is maintaining a good curve on the WHO chart. Maybe print that up and see what you think: http://www.who.int/childgrowth/stand...irls_p_0_6.pdf

8#11oz (8.68#) at birth = 3.95 kg and 9#15oz (9.94#) = 4.52kg

Looking at this curve, I would personally not be concerned about weight gain. The CDC charts are based on a population of babies that is mostly formula-fed, and breastfed babies gain at a different rate. Length and head circ. are maintaining as well, so that is also a good sign.

That's always my 1st question too - are you using the WHO charts? The WHO charts actually show that babies should typically grow more in the first 3 months of life than the CDC charts show as normal. WHO looks at normal growth at that age as about 30 g /day. So between 2 weeks and 8 weeks would you expect baby to gain about 1.2 kg. This baby gained 0.57 kg (I trust your math ) in that same time frame.

Baby was born at about the 90th percentile, and is now only at the ~20%. That is a big fall off the curve.

PP, can you get a second opinion from another IBCLC? I'd be worried about possible tongue-tie or other transfer issue. Or as you mentioned, maybe reflux is an issue. I can understand why your ped is worried - babies need to gain weight. Have they looked into any medical reasons for poor weight gain?

Supplementing with formula isn't the first or only way to deal with this. Donor milk, increasing your supply, making sure baby can transfer milk well are all options. And if you do decide to supplement with formula, remember you can supplement at the breast.

It sucks when baby isn't gaining well. I really encourage you to seek out help from a good ped who is breastfeeding supportive and knowledgeable, or who at least will refer to a good LC!

[womenswisdom]

Originally Posted by PatioGardener

Baby was born at about the 90th percentile, and is now only at the ~20%. That is a big fall off the curve.

Ah! You are so right, I'm sorry! I was looking at 2 WEEKS, not 2 MONTHS.

[Rose-Roget]

Yeah, I'd been looking at the WHO chart. I canceled my appt. with the LC for today since dd is just starting to bf again (this was the first day that she didn't have a single bottle since Saturday). I'll go in on Friday. That way she'll have had a day or two to get re-established, then they can evaluate how things are going, and weigh her.

It occurs to me that she doesn't usually eat for more than about 10, maybe 15, minutes at a time. Early on, when I had a lot of milk, she ate for only about 5 minutes, but I was told this was fine and that baby knew when she was full. Plus, every indication I had was that things were on the right track - diapers, growing... Recently, it's been closer to 10 usually, but this doesn't seem to be enough I guess. So far, though, I can't coax her to eat more than she's willing to. I don't want to push things, since she's just coming off of a strike (I want her to LIKE nursing again!). Even with the bottle, though, she intook only about 20 oz. and that was with a push to get her to drink more and long, slow sessions with a bottle.

Like I said, today she didn't take a bottle at all (in fact, refused). So far, she has eaten like this: 1:20 AM = both sides for about 20 mintues total, 5:30 = both sides 20 min. total, 7:30 = 1 side 10 minutes, 9:30 = 1 side 10 minutes, 11:30 = 1 side 5 minutes, 1:30 = 1 side 10 minutes, 3:30 = both sides 5 minutes each, 5:30 = 1 side 10 minutes. I guess this really doesn't tell us anything, since we don't know how much she's getting each time. The nighttime was a little unusual for her, waking more than usual to eat.

So what are the symptoms of a short frenulum? Her tongue movement seems normal to me and she's able to protrude it. I wonder if she has weaker oral motor, though - she doesn't suck on pacifiers long either. Or maybe she just doesn't like the pacifier as much as ds (this would not be a bad thing!) and has a poor latch, instead.

[PatioGardener]

I'm so glad to hear that she is starting to nurse again! That's awesome! Your patience and perseverence are inspiring.

Sometimes babies who are posterior tongue-tied can stick their tongue OUT but can't lift it UP to the roof of their mouth.

Rose-Roget, do you think she'd nurse more often? If you tried 30 minutes earlier (before a usual feed time) do you think she'd eat? Just an idea - may not work for you guys.

Anyway, I have my fingers crossed for you and you are in my thoughts!

[Rose-Roget]

Thank you so much for your support. No one irl seemed to really care -I think they all figured I should just put her on formula.

I went to the LC today. I do think the Nystastin is upsetting her tummy, so I didn't give it to her before going. Based on the information I gave, what she observed, and dd's weights, her guess is reflux. I'm waiting for a call back from the ped.

[SallyN]

Oh lots of hugs to you!

1st... my gut feeling is that there's something going on besides thrush. (I'm sorry I don't have any ideas... just wanted to throw support for you keeping at the doctors and LCs for finding a solution.)

2nd... get thee a hospital-grade pump. Your health insurance may cover the cost (you might need a "prescription" from your ped.) Check with your local health department... they may have hospital-grade pumps (or equivalent) for you to rent or borrow.

3rd... as to your irl people thinking you should just put her on formula... if she's not taking a bottle either, then going to formula isn't exactly going to solve your challenges. And if she is having reflux, you'll trade out the challenges of rebuilding/maintaining your supply for finding the right formula (probably one of the more expensive non-dairy ones) that doesn't aggravate the reflux. Yes... formula can be a valuable tool when appropriate. So if that's what ends up being the right thing for you and your family, then that's great that it's available. But in the meantime... come here for support while you fight for your breastmilk.

we're here... cheering you on.

[SallyN]

ps. have you done a weighed feeding? that's really the only way to accurately assess insufficient milk transfer. I'd be really surprised if your LC hasn't had you do one... (and if not... definitely consult another LC... all LCs are not equal and they have widely varying training and expertise, even among IBCLCs.)

[Rose-Roget]

SallyN - Yes, I did a weighed feeding on Friday. She took 1.3 oz on one side and 1.8 on the other - each with 5 minutes or less of sucking. The LC considered her to be a pretty efficient nurser, based on this. I have been taking More Milk or Fenugreek capsules, along with some Mother's Milk tea. That has really helped my supply. If her strike starts back up, I will definitely be asking for a hospital grade pump.

For the moment, I think her thrush is gone and her strike is over. She started on a little Zantac last night and today. While she still had a bit of a fussy time in the evening tonight, it wasn't like usual, and she did nurse this evening also! That's great because she'd been pushing her last meal of the day earlier and earlier, even before the strike. I'd started waking her up before I went to bed, but even then, she was only eating about 6 times per day.

You're exactly right - if she won't take a bottle when she's not willing to eat, then what would moving to formula do for her? I'm sure the argument would be to provide more calories. If it comes to it, I am glad it's available, but I really really hope to make it past this rough patch and get back on track - I bf'd my ds for 16 months and really cherished it, and I want to do the same for her.

[ewe+lamb]

I really admire your courage and commitment to breastfeeding your baby through all the hardships - you're doing great!

For the thrush I find that oregano capsules work great - 3x3daily for 3 weeks and it really irradicates it you may wish to give it a go.

You dd sounds as if she's a really efficient nurser, but I am just thinking of an imbalance of the fore/hind milk especially with the weight gain issues, not that you're producing too much milk it may just be too much foremilk at this stage which may make her uncomfortable/gassy - the arching of the back suggests this to me - maybe worthwhile checking this out, maybe pumping and having a look at what you get out would be interesting - although I know that pumping doesn't always give you what the baby is actually getting, you could pump and take the cream off the top and give it to her to up the calories as well, if baby is only nursing for 5 mins on one breast then maybe the next time she wants to nurse you start off on the breast she just nursed on so that she gets the creamier milk - these are just ideas see what you think!

[sahmmie]

Definitely sounds like it could be reflux. I had two reflux babies and it took me almost 5 months to figure it out with my second because his symptoms were not the same as my dd's. Reflux tends to run in families, so with the family history and her symptoms, I think reflux is very possible. Here's a good site for information on infant reflux. www.infantreflux.org

Good luck. I hope things improve soon.

[Youngfrankenstein]

Originally Posted by ewe+lamb

if baby is only nursing for 5 mins on one breast then maybe the next time she wants to nurse you start off on the breast she just nursed on so that she gets the creamier milk - these are just ideas see what you think!

Along these lines...I would try to get her to take the "first" breast for much longer. If she nurses for 5 mins and stops and you burp her, etc. I'd stick her back on the same side again.

I had oversupply issues and realized dd was getting too much foremilk. In my circumstance, I only feed her one side per feeding. For you, I'd just let her do most of her nursing on the first side and let her have more from the other if she's still hungry.

I don't know if there's a time-limit way to tell, but she maybe just needs more hindmilk.

[Rose-Roget]

She's been on reflux meds for about a week. They are working to the extent that she will eat a little in the evenings, when she flat out refused to before. So that's good. But she still has a lot of pain, arching and crying. It's weird because it's really gotten more pronounced in the past few weeks, and now it's to a point that the meds aren't even masking it.

I've tried to feed her some of the cream off of expressed milk, but then I feel like I need to toss the bottle if I've taken most of the cream off of it - is this the case?

Based on what she at the LC visit, I estimate that she eats about 1.5 ounces during a 5 minute feeding. This would mean that she would need to have about 17-20 5-minutes feedings during a day. If she nurses for 10 minutes, I count that as 2 5 minute sessions. So far, we've been lucky if she makes it to 13 5-minute sessions per day - which if they are approximately 1.5 oz each is just not enough. I don't know how to make her eat more. She usually pulls off after 5 minutes and will not continue. I can work to burp her, which is rarely successful and usually evokes wails of pain when I'm trying. Usually the burps/gas work themselves out on their own, sometimes less painfully. But this can often take close to an hour. And then I continue feeding her again. I've moved back to more block-feeding style, trying to get her that hindmilk, but I haven't noticed a big difference.

[PatioGardener]

FYI, often the first line of reflux medications don't work well enough for some babies. You may need to go up a step.