how to get this kid to eat?

[aeterna]

My son was born 9 hours ago, and really isn't demonstrating much interest in breastfeeding (or eating in general)... He'll root around and suck on his hands, but when I put him to the breast hr gives it a few seconds of half hearted attempts and then go to sleep.

It doesn't look like my milk has come in yet, so maybe he's just discouraged? But he's not wailing with indignation over his hunger, either... He's awake and alert, or sleeping happily. The nurse is recommending sugar water on the nipple to encourage him to keep working at it, and we're doing skin to skin. What would be the recommendations of the lovely ladies here?

[CookAMH]

Keep up with the skin to skin. NO VISITORS! Getting baby to latch and stay on is #1. Are you pumping to encourage milk flow? Collect your colostrum and either finger feed or feed by syring until he gets latched. Can you ask for a lactation consultant? Does baby get a good strong suck on your finger? If baby gives up at that, I'd check his mouth for tongue tie, just to rule that out with causing difficulty. You want to get that baby nursing soon. There are different ways tongue tie can look but here is one pic.

Was your birth medicated, or a c/s (are you on any medications that might make baby sleepy?)

[aeterna]

I did start pumping (OW that is uncomfortable!!) and am feeding the colostrum via syringe for now. (we attempt to nurse, then I pump 15min, then we try to latch again while my nipple is protruding like a damned drawer pull, lol.) I got 2ccs at the attempt 2 hrs ago (from both breasts combined) and this attempt I got 2ccs from my left and a little less from the right, but I had to dump that BC it was pretty bloody (apparently I got a crack. Ow. I am using my lanolin, but it's just a lot of stress on virgin nipples!).

He can get a pretty strong suck on the breast, he just usually doesn't seem inclined to do it. He pulls his head back, or bobs it on and off the breast, or opens his mouth wide, gets a big mouthful of nipple, and stares at me without sucking. Brat, lol!

Unmedicated, very fast birth. I got a Tylenol 8 hrs later because I had a slight fever that they wanted to correct so they wouldn't have to call the Dr. he's had a vitamin k shot, nothing else. He is not circ'd either, so no shock issues there.

He is sleeping and reluctant to let me check for a tongue tie, so I'll look for that when he's awake. And I'll check with the lactation consultant tomorrow - I asked for one today but they were out for some reason. I just want to make sure I don't bow to remedies that will only maker things harder for us going forward! Thanks for the feedback. =)

[Megan73]

Congratulations on your new baby!
Sleepy newborns can get into a vicious cycle - too sleepy to nurse, not nursing makes them sleepier.
I find hand expression works MUCH better than a pump with tiny volumes of colostrum and is much easier on your nipples. I'm concerned that you had a crack 9 hours PP. Do you have correctly fitted flanges on your pump?
What I did with DS2 is make sure we were skin to skin-to-skin basically 24/7 until breastfeeding was established - a wrap is great for this and you can put a zip up hoodie on over it - and spoonfed him the hand-expressed colostrum until my milk came in.

[aeterna]

It is a fairly tiny crack, just bleeds more than I'm producing colostrum (which is more a commentary on low production than on excessive bleeding, lol).

It does not look like he had a tongue tie, but neither is he USING his tongue much. He's got the jaw compression down pat =P just isn't extending his tongue correctly.

I did need bigger flanges =) and also got my pump switched out for something gentler. We also worked with the LC on positioning today and he's at least trying, even if he's not getting much/anything. Trying to do more skin to skin!! Its challenging BC my nipples are tender, And this kid is a hot box... Put him on me and he starts pumping out the heat. We're wearing nothing but a sheet and I'm sweating, lol... Which makes his skin stick to mine, which is really uncomfy on the nips. Kinda want to just stick a disposable pad over each nipple to keep them protected. >.>

time to try again! =)

[mambera]

My DD1 was just like that - fine latch but no interest in eating.  I ended up with a permanent supply issue.  Good for you for seeking help early.

I agree with all the above advice, esp the constant contact with baby, and would emphasize to keep giving baby opportunities, constantly.  Eg wake to feed every 1-2 hours during the day and every 2-3 at night.  Tickle feet, rub head, undress, even a cold washcloth to the toes if he won't wake.  Feeding on demand is not ok if your baby does not demand yet.

Eating is way more important than sleeping for him right now.  It's only for a short time - the window for supply establishment is the first two weeks.  A little sleep loss for you now will pay off later.

Agree with hand expression over pumping early on - gentler on your nipples and likely more effective.  Don't worry about colostrum volume, it is tiny. 2ccs = totally normal.  I would skip the sugar water and just express drops of colostrum to tempt baby to suck.

Did anyone show you the tongue-extending exercise?  Give baby your pinky to suck, nail side down.  Press down and withdraw gently while baby sucks to encourage tongue extension.  If tongue is not correctly positioned it will feel like he is biting - could that be contributing to the nipple crack?

[aeterna]

Things are getting better! The little crack has healed and although I still do not think he is using his tongue appropriately, I'm not having any soreness (well, any unexpected soreness.... I'm a bit achy from breast fullness but my nipples are generally ok) and my supply is improving. Last night he was gassy and wanted to nurse for comfort, but wasn't puling hard enough to get any/much actual milk, and then when I'd try to pump I wouldn't let down at ALL, so I got pretty z sore this morning and just wanted to let off some of the pressure. We got some gas drops now so hopefully that will help too. He is definitely showing more interest in nursing ... At least for ten minutes or so, and then he's back to sleep. But it's a start! =)

Re: getting help early : I promised myself that would be the ONE lesson I took from the mamas here. Heard SO many women say "it was bad, then finally I got help, I don't know why I waited so long." And I really want to do this for him, but I'm a lousy martyr, so I'm just gonna leech off your collective experience and try to save myself some trouble!

Also, apologies in advance for typos and irregularities... Hard to post from the phone!

How do you hand express? Like with a manual pump or literally by hand into a cup or something?

And, he bites my finger (and then fusses at me for trying to fake him out) but doesn't really bite the nipple. He did once, but not regularly.

[Megan73]

Literally by hand into a cup. Here's a video: http://newborns.stanford.edu/Breastfeeding/HandExpression.html

I'm glad things are going better! Keep us updated

[aeterna]

Thank you! That's a great vid and the hand expression worked quite well. I'll keep working with that - I have to relieve some of this pressure and it's important for production, obviously - I just wish he'd take more interest in nursing. He will take what I express quite happily, but I am afraid he'll get used to feeding easy mode via syringe... but he's not giving me hunger signs and he is still pretty listless/disinterested in latching.

[Megan73]

Hmm. How are his poos and pees? Has he been weighed at all? Has he been checked for tongue tie?
I think you're doing the right thing by 1) feeding the baby without bottles that can lead to flow preference and 2) protecting your supply. If he's not nursing effectively, you need to remove milk thoroughly and often - like every two hours with one longer four-hour stretch of sleep at night. Mambera is totally right that otherwise you can risk permanently reducing your supply.
I'd be a bit concerned that he's still not interested in nursing. Is there an IBCLC near you? What does your MW say?

[aeterna]

Seems like it's a different problem every day. This is where we're at right now:

--the LC at the hospital checked him for tongue tie and said he was fine.

--He was weighed while we were at the hospital, but we went home yesterday and he hasn't been weighed since. He was born 12/06 at 12pm @ 6lbs 15.5oz, his last weight was just prior to discharge, 12/08 at 9:30am @6 lbs 9.2oz. His TCB on 12/07 was fine (he was a 7 and they said anything under 14 was ok) so they did not do a blood draw to test bilirubin.

--His pees and poops are inadequate. Yesterday we had one wet/messy diaper that WE confirmed... the hospital had charted two pees before we were discharged but he was only out of my room once and only for about half an hour (to get rechecked by the ped for a heart murmur). So I don't know that I believe he had two wet diapers the single time he was out of my sight =P and then we had one more wet/messy diaper very late that evening (so it would've been 9:30am and 11pm, yesterday). Today we've had one wet diaper so far, about 9:30am.

--He is attempting to nurse pretty often, but more for comfort than for food, from what I can tell. He is very, very gassy and it's bothering him a lot. We're doing the gas drops, and trying to burp (though frequently he doesn't) and do pedal-feet, but he gets pretty inconsolable about it - for about a minute, then he farts and is fine. He roots for the breast but when offered, sort of... mouths it more than nurses, y'know? And when he's not uncomfortable and we're just trying to bf, he can sometimes get a pretty decent little latch and 3-5 good pulls and then his eyes are drifting off closed and no amount of getting him naked, tickling his chin, or washing his face with a cool rag will convince him to wake up for more than a few half-hearted tries.

--I am still not letting down for the pump, at all. Maybe half a dozen drops on the left but the right refuses to give anything. I've tried hand-expressing first, pumping while he's nursing the other side, pumping between feedings... it's just not working. Hand-expression works, it just takes FOR.EV.ER. ;) I'm not engorged (I'm able to soften the breasts pretty well with a thorough hand expression) but they are definitely full and achy and it seems impossible just to keep up!

I know he is hungry, he will eat whatever I hand-feed him... we just nursed (which is to say, 3-5 good pulls followed by an aggregate 10 minutes of attempts over 20 mins or so) and then he ate 5mLs of EBM with gusto.  But that was the first EBM I'd given him since 8:30a (I've been taking the night shift, and DH takes over in the morning so I can get some solid sleep) and I'm not convinced he was getting much just from nursing when I woke up to feed him between then so I'm just not sure he's getting enough. I think I need a scale so I can weigh him obsessively to calm my fears. -.-

Feeding times so far today: 0130, 0300 (comfort then 2.3mL EBM), 0600, 0830 (comfort then 2mL EBM), 1230, 1330 (comfort, and I expressed but didn't feed EBM bc he was finally resting comfortably), 1430 (comfort then 5mL EBM).

Wow, wall of text. Sorry. It helps me to keep it written down so I don't have to remember it - I might print this out and take it to an LC on Monday. 

[Megan73]

I can see why you're concerned - the diapers and continued sleepiness are worrying.
Any chance you can see someone before Monday? A LC will have a special scale to see if he's transferring any milk.

[womenswisdom]

You might want to get a second opinion about the tongue tie. If the tongue's motion is not correct, you very well may be dealing with a posterior tongue tie and will want to find someone who has a lot of experience to evaluate and correct it. I would start contacting LLL leaders asap for referrals. If he can't move his tongue appropriately, he can't draw the nipple far enough back and will not transfer milk appropriately. Posterior tongue ties are tricky to find and many LCs miss them, IME. Here is one way of checking if you want to try yourself: http://www.youtube.com/watch?v=5opSbXvL7yQ but it really should be evaluated.

[aeterna]

Thank you.

I am by no means an expert on this, so I had DH snap a photo mid-wail.  What do you ladies think re: tongue tie? I'll certainly ask for a second (local) opinion (I found a list of IBCLCs local to me, just need to find one who's available over the weekend!) but thought I'd share a pic, too.

In brighter news... he's been eating like a champ, today. It's heartening. Thank you ladies for helping keep my spirits up. =)

[womenswisdom]

DEFINITELY tongue tied. That line in the middle is not supposed to be there at all. There should be no ridge or bump when you run your finger around the base of the tongue and he clearly has a tie. Call around to LLL leaders and find out who in your area is skilled at assessing them. As you've seen, some IBCLCs are good, and some can't identify a very obvious tongue tie. You might ask if they are familiar with the Hazelbaker scale to start with. It's a known way of evaluating tongue tie, function and appearance and the need for correction and an IBCLC who is familiar with it will likely have good knowledge of tongue tie issues.

Glad to hear things are improving though!
Edited by womenswisdom - 12/10/11 at 4:44am

[Megan73]

I'm no expert but I've had two TT kids. It looks like a mild tie to me. His tongue isn't heart shaped and he can lift if pretty far. Can he get his tongue over his lower lip when he's latched? Clipping it would do no harm and could do some good if there's someone nearby who could do it.
I'm so glad things are going better!

[PatioGardener]

Originally Posted by womenswisdom 

DEFINITELY tongue tied. That line in the middle is not supposed to be there at all.

A TT could explain your nursing difficulties. Hope you can find someone to take a good look and clip!

Hang in there!

[CookAMH]

I was just going to post my disagreement with the initial assessment by the LC for TT mainly because of the "symptoms" you have mentioned....and others already did. And you posted a pic. Looks like it is tight. I can't think of any other reason why he'd give up so quickly nursing unless it was hard for him to get a good latch for LONG enough with a tight mouth. Might be strong at first, but he would tire out. The gassing is another big sign to me of TT - he's taking in so much air with an incomplete latch.  What about his upper lip? Lips can be tied too and lessen the quality of latch. He's a baby, he wants to eat, if he COULD eat well (with a free mouth) I am confident he would go to town.

Please get someone ASAP to check it out and get it clipped if necessary.  This will make A WORLD of difference once it's clipped.  Some babies nurse forever when TT in order to get enough milk (and grow well) and some babies just can't stay on (as was the case with my dd before she was clipped).

This site is helpful for assessing tongue tie. http://www.kiddsteeth.com/articles/breastfeedingdrkotlowtx.pdf Great to analyze it when he's crying.

I don't know if this is a lead to a local resource for you or not. http://www.nortonhealthcare.com/body.cfm?id=10&action=detail&aearticleid=001640&aeproductid=adam2004_117&aeprojecttypeidurl=apt_1

Pediatricians typically don't do clippings. A knowledgeable LC will have a name or two for you.  Post on your local board for a referral as well.

[aeterna]

Thank you! I'd done a lot of reading during the pregnancy so I knew what TT was and had seen some pictures of what it looked like etc., but since I'm a ftm I didn't feel comfortable arguing with the "pro"... Even though I suspected this WAS a tie, dammit. -.- (stick to your instincts, mama!!)

Was unable to get ahold of an LC for the weekend but will keep trying. And I'll check the local board for recommendations (although I know one orthodontic surgeon who does them already). I'll update here when I have more news. until then, we are just trying to keep the little man fed. =)

[CookAMH]

Great, finding someone to do it (and give another opinion before doing so) is great! Hopefully he can see your babe soon. Keep us posted!!  :)