Nipple Confusion in 3 Month Old - Mothering Forums

Forum Jump: 
 
Thread Tools
#1 of 13 Old 02-05-2009, 01:17 AM - Thread Starter
 
Dark Aisling's Avatar
 
Join Date: Feb 2009
Location: Calgary, Alberta, Canada
Posts: 66
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
My son (DS2) is nearly 3 months old, and today I saw a lactation consultant who actually took the time to try to diagnose the problem we're having: nipple confusion. Up until today I'd been told that he was just "a sleepy nurser."

I won't get into all the "whys" of this (there are many) . . . I'll just say that this mess started in his third day of life, and has been compounded by the advice of several medical professionals. Realizing that he won't just "grow out of this" is heartbreaking.

He does nurse at the breast, and he seems to find enjoyment in it. I guess I'm lucky that he hasn't rejected the breast completely. He's quite ineffective at the breast, however, and he is supplemented by around 18 ounces a day (12 oz breast milk, and 6 oz formula). He's gaining weight very nicely . . . now. His weight has been a real struggle.

His latch has always been poor (I left the hospital with blood blisters on my nipples), and while it has improved it is still a long way from ideal (nipples wind up pinched like a lipstick). He nurses vigorously for a couple of minutes, and then he slips into a "bottle suck" (according to the consultant I saw today).

Originally I had planned to nurse him for at least a year, but now it looks like this might be in jeopardy.

I'm going to start using the SNS again tomorrow. I had been using it a month and a half ago, but he wasn't taking enough of the supplement to gain weight with it so he had to go back on a bottle.

I'm hoping to have this all worked out within a couple of months. Any advice regarding the correction of his latch, phasing out bottles, and supplementation would be greatly appreciated.
Dark Aisling is offline  
#2 of 13 Old 02-05-2009, 06:43 PM
 
Megan73's Avatar
 
Join Date: May 2007
Location: Canada
Posts: 2,503
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I don't have exactly the same problem but I do use a Lact-Aid to supplement my six-month-old with formula (10 oz a day) due to unexplained low supply. It's great that you're able to pump so much to supplement!
Everything I've read – on Kellymom.com or Dr. Newman's site – is that getting rid of the bottles is the first priority.
What I found helpful as I was battling various problems – not gaining, refusing the breast, falling asleep at the breast, latch issues – is to rent a baby scale. That way you know if he's transferring and if he's gaining.
I wholeheartedly recommend the Lact Aid. But if you're using the SNS for now, what size tubing are you using? You might try a larger size.
Did the LC give you instructions on how to work on his latch? Both the sites offer help with this.
Don't give up, mama! You can do it. I know how hard it is to struggle with breastfeeding but I'm so, so glad I persevered. My son is gaining steadily and loves being at the breast and I'm so grateful for our nursing bond.

Megan, loving her sweet rainbow1284.gif boys, born Aug. 2008 and Feb. 2011, and their sister, born still March 2007 candle.gif
Megan73 is offline  
#3 of 13 Old 02-06-2009, 01:19 AM - Thread Starter
 
Dark Aisling's Avatar
 
Join Date: Feb 2009
Location: Calgary, Alberta, Canada
Posts: 66
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Thanks again, Megan

I'm able to pump between 10 and 15 ounces a day, on most days. I had a slack day today though, as I was waiting for someone to come over to pick up the scale I had rented. I hate trying to untangle myself from a breastpump when the doorbell is ringing.

The amount I pump in a day is about to change though. One of the times I do the most pumping is in the middle of the night, when DS gets a bottle. I got rid of that bottle last night, so I'll only pump what's left after DS is done. I also pump for 10 mins on, 10 mins off, for an hour and a half every night after DS goes to bed. My pumping sessions during the day vary . . . today I didn't do any.

I started pumping the day my milk came in, and I think that has done wonders to preserve my supply (which isn't sufficient, even with Domperidone).

I've come off the Domperidone as the amount I was taking wasn't doing anything.

I just decided a week ago to get rid of the scale I was renting. DS is now doing really well weight wise, and I'll just be having him weighed once a week at the clinic from now on. The scale was really useful, and he's out of the critical zone and back up to the 50th percentile. On New Year's day he was in the first percentile . . . so we've made some really good progress as far as his health goes in the last month.

I use the large size tubing on the SNS. I wasn't, however, using the SNS according to the instructions. I was using it as demonstrated in a video on Dr. Newman's site. When I use the SNS tomorrow I'll try using it according to the instructions, and I'll see if that makes a difference.

I have an appointment at a breastfeeding clinic on Wednesday, with a doctor (Dr. Mary-Jo Woolgar,
the Breastfeeding Medical Advisor for the Calgary
Health Region) who comes highly recommended by a number of women I've spoken to. I'll be asking her where I can purchase the Lact-Aid, but I'm also going to bring my SNS for direction from her.

The LC I saw yesterday wasn't particularly helpful. She showed me the "chin pull" move, and that was about it. She also told me not to give DS any pacifiers or bottles, but in the next breath she told me to give him a bottle if I couldn't get him nursing well within 15 min : Go figure. She didn't seem particularly interested in helping us, and she didn't listen to me very well either. She also muttered, under her breath, that this might not be fixable.

It will be nice to actually be under the care of a physician who has the goals of correcting and supporting breastfeeding.

Your words of support mean a lot to me. The position you're in now is the one I want to be in when DS is six months old.
Dark Aisling is offline  
#4 of 13 Old 02-06-2009, 12:41 PM
 
Llyra's Avatar
 
Join Date: Jan 2005
Location: right here
Posts: 9,450
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I've battled nipple preference twice now, and I have a lot of ideas. I wish I had time to post a long time right now. I'll try and get back on MDC once the babies take a nap. A few things, though: first, I agree to stop all bottles and pacis. Just stop them. Throw them away, or hide them in the car, so it's not tempting you.

When you use the SNS, do you tape the tube on so that the tube protrudes about an inch past your nipple? The tube has to reach as far back as the nipple in his mouth, and the nipple gets pulled out to the back of his palate when he latches. Also, have you tried propping the SNS bottle WAY high, like above shoulder height, and squeezing it gently, to increase the amount of supplement he gets. Do that whenever he stops actively sucking, to tempt him to stay on the breast longer. You don't want to do it forever, but for a few days in order to make sure he's getting the supplement while also stopping artificial nipples.

I would try and get him his supplementation exclusively at the breast from now on. If you entirely stop any other sucking, it's very likely that he'll start taking a greater interest in effective sucking at the breast. We went through this with my son, and it took about a week for him to be nursing exclusively again, but he then went on to nurse for 16 months. We, and his pediatrician, had entirely given up on breastfeeding. Luckily I found an LC that refused to accept that situation and coached us through the hard parts.

As far as the latch-- don't be afraid to be fussy about that. If his latch deteriorates, gently take him off the breast and try again. It can be REALLY intensely discouraging to do that, especially if it took him awhile to get latched in the first place, but you have to insist that he break the sloppy suck habit. If he resists re-latching, leave him be and try again 15 or 30 minutes later.

In the meantime, nurse often. Nurse in lots of different positions and circumstances. Nurse in the tub, while walking around, lying in bed. Nurse as often as you can get him interested. He needs the practice in latching and sucking, and you need your supply stimulated. Continue to pump and add that to the SNS. Once he's nursing more effectively, you can deal with weaning from that. Try to pump everything he needs, and phase out the formula. Stay skin to skin and nurse often through the night.

It's nice if you can get somebody else to handle your other responsibilities for the few days you'll be really intensely working on this.

me knit.gif, he bikenew.gif, my three reading.gif, sleepytime.gif, and fairy.gif-- and the one we lost angel2.gif
Llyra is offline  
#5 of 13 Old 02-06-2009, 03:15 PM
 
Megan73's Avatar
 
Join Date: May 2007
Location: Canada
Posts: 2,503
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I'm so glad you're going to get some good help. Good for you for seeking it out! That LC sounds awful, frankly. Llyria has much better advice!
It's so frustrating but unlatching and relatching is worth it. There seemed to come a day when my LO just "got it." As Dr. Newman says, babies learn to breastfeed by breastfeeding.
How much dom were you taking? I'm on three pills three times a day, which is what Dr. Newman suggests although he says some women can go as high as 4, 4X a day.
Good luck – I'm here for you

Megan, loving her sweet rainbow1284.gif boys, born Aug. 2008 and Feb. 2011, and their sister, born still March 2007 candle.gif
Megan73 is offline  
#6 of 13 Old 02-07-2009, 12:11 AM - Thread Starter
 
Dark Aisling's Avatar
 
Join Date: Feb 2009
Location: Calgary, Alberta, Canada
Posts: 66
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Well, we've gotten rid of all of his bottles today. I'm not sure if we'll get all of his supplement into him. i think we'll be about 4oz short. I'm quite sure he picked that 4oz up at the breast though, as my pumping is down by around eight ounces so far today. It will show up quite quickly in his stools so I'm not worried.

I did follow the instructions on the SNS as far as tube placement, and I hiked it up to my chin. He may have gotten the supplement a little too quickly . . . but at least it is a start!

I haven't been really picky about latch today. I'll wait to see what the doctor has to say on Wednesday, and I'll adjust as per her recommendations.

He's been off pacifiers for about a week. He just refused to take them anymore . . . he's discovered his fist, and likes to suck on that.

I'm lucky in that I don't have too many responsibilities around here right now. DP realizes that caring for our LO really is a full time job, and he takes care of virtually everything.

As for the Dom . . . I was taking 1 10mg pill 4 times a day. It was prescribed by my GP and he was clearly unaware of the amount recommended to increase lactation. I'll talk to the doctor on Wednesday to see what she recommends.

Thanks for your support, ladies!
Dark Aisling is offline  
#7 of 13 Old 02-08-2009, 08:31 PM
 
Llyra's Avatar
 
Join Date: Jan 2005
Location: right here
Posts: 9,450
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Dark Aisling--

How's it going? I just wanted to check in and see how you're doing. I hope you're seeing some progress, and babe is nursing better.

me knit.gif, he bikenew.gif, my three reading.gif, sleepytime.gif, and fairy.gif-- and the one we lost angel2.gif
Llyra is offline  
#8 of 13 Old 02-08-2009, 10:46 PM - Thread Starter
 
Dark Aisling's Avatar
 
Join Date: Feb 2009
Location: Calgary, Alberta, Canada
Posts: 66
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by Llyra View Post
How's it going? I just wanted to check in and see how you're doing. I hope you're seeing some progress, and babe is nursing better.
Thanks for asking

Still no bottles or pacifiers . . . I've locked them in my car. I'm going to switch to the medium flow SNS tube tomorrow.

I'm taking another shot at both Fenugreek and Dom, but I've doubled the dosages of each that I was previously taking. I'm hoping that the doc on Wednesday will right a script for the Dom at that level (2x4). I don't have enough to keep going at this rate for long. It would be ridiculous for a Canadian to order it from Thailand.

DS has adjusted well to the change. His nursing has improved a bit. He's being supplemented by 8oz breast milk and 4oz formula. He seems to be content at that level of supplement. His bms have changed: greater frequency, smaller size, and fewer curds. I'll see what has happened with his weight on Wednesday. I would prefer not to add any supplement back in to his diet.

I haven't had to use any Ovol or gripe water in two days :

Without his 2am bottle he's grazing from 2am until 8am. We co-sleep, so that works just fine logistically. I'm not sure what this will do to my supply. My 2am pump is now gone. I'm pumping less, but supplementing less, so I'm assuming what I'm not pumping is going into him.

And the best part . . . twice when I was nursing him yesterday he came off my breast, gazed up at me, and gave me big smiles

I'll post an update on Wednesday after we see Dr. Woolgar.
Dark Aisling is offline  
#9 of 13 Old 02-09-2009, 09:13 PM
 
smeep's Avatar
 
Join Date: May 2006
Location: Dallas, TX
Posts: 2,812
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
Okay, I'm just skimming so forgive me but how are you judging what he takes directly from the breast (SNS contents excluded)

- Emy . Single mom to DS nut.gif Ezra (15.12.05), angel2.gif Thames (reincarnated 18.04.08) and DD rainbow1284.gif babyf.gif Allora (11.02.11) and dog2.gif Hoppylactivist.gif  novaxnocirc.gif  waterbirth.jpg fambedsingle2.gif bfinfant.giffemalesling.GIFcd.gif

smeep is offline  
#10 of 13 Old 02-09-2009, 09:56 PM - Thread Starter
 
Dark Aisling's Avatar
 
Join Date: Feb 2009
Location: Calgary, Alberta, Canada
Posts: 66
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by smeep View Post
how are you judging what he takes directly from the breast (SNS contents excluded)
I suppose there are almost two answers to this.

The first would be that I'm not, right now. We're just kind of going with the flow.

The second (putting on my engineers hat) would be that I determined the average number of calories that an infant his weight required in a day to maintain his weight. I then weighed him four times a day and calculated a daily average. I calculated how many extra calories he consumed to reach this new weight. So, I have daily average (a) and extra calories (b). Next, I divide his estimated daily caloric consumption by the total number of calories in an ounce of breast milk or formula. This is roughly 20 cals an ounce for either. So, (a+b)/20 equals the total ounces consumed. Subtract the amount supplemented (d) from this: [(a+b)/20]-d=x, where x is the approximate number of ounces consumed at the breast. I don't think I missed anything. I haven't done this since Thursday, though.

DP thinks I'm nuts.
Dark Aisling is offline  
#11 of 13 Old 02-11-2009, 11:24 AM
 
smeep's Avatar
 
Join Date: May 2006
Location: Dallas, TX
Posts: 2,812
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
I think I get it? haha. I'm way too sleepy right now.

Still no bottles? Kellymom has a great page for weaning off of supplements but the schedule she gives is just an example, go as your babe is ready. As long as he's having enough wet diapers there's no need to worry. A slight drop in weight may occur if you go on the faster end but as long as it's not considerable and wet diapers are adequate, there's no need to worry.

For what it's worth, my DS developed nipple preference at 3 months because my supply got low (and thaat was due to not having the right pump for me, being lazy some days at work, not knowing a lot of things in general that would've been helpful). I did it the really hard way. Got rid of the bottles. Just offered breast only. He refused tons, lots and lots of fights and almost no sleep and he even lost a bit of weight due to my supply and his refusal, but it was worth it. A week later he didn't fuss for the majority of nursings and a month later it only happened when he was already in a crabby mood and wanted something to complain about. It was the biggest problem we faced and I couldn't have been more proud of myself! Nipple preference is tough and any woman who even tries to get through it, success or not, is amazing.

ETA: What I call nipple preference is when a baby refuses the breast for a bottle. What I call nipple confusion is when a baby gets a poor latch/suck on the breast from using a bottle. But not everyone defines the two that way.

- Emy . Single mom to DS nut.gif Ezra (15.12.05), angel2.gif Thames (reincarnated 18.04.08) and DD rainbow1284.gif babyf.gif Allora (11.02.11) and dog2.gif Hoppylactivist.gif  novaxnocirc.gif  waterbirth.jpg fambedsingle2.gif bfinfant.giffemalesling.GIFcd.gif

smeep is offline  
#12 of 13 Old 02-11-2009, 05:53 PM - Thread Starter
 
Dark Aisling's Avatar
 
Join Date: Feb 2009
Location: Calgary, Alberta, Canada
Posts: 66
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Well, we've had our appointment with Dr. Woolgar. Based on how things have gone over the last week she wants me to make the following changes:
  • Return the Symphony
  • Stop pumping to increase supply (use DS and domperidone to increase supply)
  • Pump with PIS ONLY in the event breasts are still very full after his first morning feeding
  • Give no more than 2oz of formula as a suppliment per day, and only using SNS
She's really confident that we can get everything all sorted out : I'm so pleased that I can stop the pumping insanity!

Thanks, so much, for your support and suggestions ladies! We would not have come as far as we have in the last week without you.

I see her again next Wednesday. She'll decide then if I need to take more dom (she figures I will). My LO only gained 3oz this week, but as his average daily suppliment was cut by 8oz we've done really well.
Dark Aisling is offline  
#13 of 13 Old 02-11-2009, 09:51 PM
 
Mamato3wild ponnie's Avatar
 
Join Date: Jan 2007
Location: hopefully close to bliss
Posts: 2,093
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Great advice from the LC/DR you just saw....3ozin one week is normal...a typical bf baby should gain 1/2 oz to 1 oz per day....so looks like your little one is right on....3oz in 7 days...1/2 oz a day. Also scales can be different from doc to doc....so your baby may weigh a few oz more....The whole idea of having a scale at home is this....weighing the baby before and after a feeding in grams...that way you can see how many grams/oz the baby transferd from the breast. There is a certain number of oz a baby should take in per feeding...according to his/her weight.
Did the Doc/Lc do a intake weight? If not...ask if they could at the next appointment....sounds like you are right on track...keep up the milk making powers mama.

Mami to fly-by-nursing2.gifds 4 wks, ds 2yo, ds 6yo, dd 11yo, ds 17 yo. novaxnoIRC.gifwaterbirth.jpg
Mamato3wild ponnie is offline  
Reply

Quick Reply
Message:
Drag and Drop File Upload
Drag files here to attach!
Upload Progress: 0
Options

Register Now

In order to be able to post messages on the Mothering Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
If you do not want to register, fill this field only and the name will be used as user name for your post.
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may post new threads
You may post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off