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Old 09-11-2006, 12:33 PM - Thread Starter
 
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My SIL is having lots of problems and I need some advice.

Her baby is 2 weeks old. She was born at 37 weeks. (I think her dates were wrong and she was more like 35) She was 6lbs at birth. She lost in the begining but was back up to 6lbs at 4 days old. Cinta thought she was fine. Then the mw checked her weight at 1.5 weeks at she was down to 5'8. Cinta got mastitis. The baby would suck for 30 min. and take in 1/2 an oz. I went over on Fri and the baby was majorly dehydrated. She hadn't pooped in 2 days. Her pee was yellow, soft spot sunken, skin baggy and hanging and grey. My other sil nursed her and got 6 oz in her. During the rest of the day we managed to get about 10 oz in her. The difference was amazing. (It took a syringe and 3 of us bf her) The mw wanted her to nurse, pump and top the baby off. We were fighting the mastitis with herbs, using alternating heat and cold packs. We got the baby to take a bottle too. The next day, Sat, Cinta went on a really low dose antibiotic, cause we couldn't even get a drop out of her right side.

Two hours later she pumped out 2 oz of puss. Then 2 hours later she was pumping out milk with weird jelly globs in it. She also had stringy spaghetti looking things coming out. She felt better and the baby was getting more with nursing and the bottle. Sunday she was nursing great and drinking the bottle great. She was back up to 6 lbs.

Now this morning, she won't nurse and won't take the bottle. She's back down to 5'12. Two mamas tried nursing her and she only took in .5 ozs each time. It took her 2 hours to drink 1 oz from the bottle. She won't suck.

Before, her suck was great, super strong. She's not tongue-tied or anything. What does this mean? Why won't she suck? Why won't she nurse? I understand why she couldn't get anything from her mom before cause she was so backed up, engorged and infected. But why the regression? Cinta wants to take her to the hospital, but I'm really hesitant.

Please any advice is sorely needed and would be greatly appreciated. Thank you so much.
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Old 09-11-2006, 12:54 PM
 
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A new baby only taking .5 or 1 oz at a time is actually pretty normal. She just needs to nurse in tiny bits ALL the time. Is she dehydrated now? I would get rid of the bottles- they are too likely to complicate the situation further. Keep up with the syringe and maybe try cup feeding or finger feeding (directions on Kellymom if you need them) It sounds to me like just an early baby with early baby problems. She needs to be getting little bits of milk around the clock- don't let her go more than 2 hours (TOPS) without a few drops at least. Better every hour.

good luck!

-Angela
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Old 09-11-2006, 01:08 PM
 
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I second getting rid of the bottles altogether. Mom needs to nurse her as frequently as possible. Make sure mom is getting lots of rest. Perhaps keep pumping too when baby is too tired to suck, just to keep the stimulation there and milk supply up. Watch for at least six to eight good and wet diapers a day for good hydration. If she still won't eat she may need to be seen by someone. Is it just that she may be sleepy? My baby was sooooo sleepy sometimes. Maybey try waking her up a bit more before feedings by stripping down to just a diaper? That is all I can think of but surely someone else on here must have some other ideas too!
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Old 09-11-2006, 04:32 PM - Thread Starter
 
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bump! Please! I need some help here!
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Old 09-11-2006, 04:34 PM - Thread Starter
 
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Oh ya, and thank you alegna and wahoowhippets for your help! We've tried the whole stripping thing and stimulating and cool cloths etc. When she is nursing her mom we have to stroke by her ear and rub her feet etc just to keep her sucking. Oh don't even know what to think anymore.....
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Old 09-11-2006, 05:34 PM
 
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I would keep on seringe feeding and have mom keep pumping, It sounds to me like perhaps being an "early" "smaller" baby she may be getting very little milk by actually nursing because she may lack the stamina and fat pads in her cheeks. Oh course I am not an LC so this is mho but I attended a LLL conference on slightly early babies and the problems can they have BF and it sure sounds like what they talked about. One of the tips was to suppliment first with bm and then put the baby to breast so that the baby gets hydration and nutrition easily with out getting overly tired and then gets to practice nursing as the reward instead of the other way around. I'll see if I can find any links to the info and post them in a bit. GL

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Old 09-11-2006, 05:46 PM
 
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First, I would cross post in the preemie forum. Those mamas have the btdt for this situation. Having had a 35 weeker myself, I completely disagree with getting rid of bottles. This baby is clearly demonstrating that she isn't ready to nurse full time. At 37weeks some babies are, some aren't.

Preemies get really worn out sucking. If babe is nursing too long she's burning as many calories trying to bf as she can take in. I'd suggest limiting nursing sessions to 30min max so babe doesn't wear herself out. Mom should pump to stimulate and baby should be offered ebm by syringe or bottle after every single feeding.

My more conservative advice is to alternate nursing + bottle sessions with a bottle/ syringe/cup only session (w/Mom pumping obviously). Let babe build up strength before pushing to go to breast full time. Lots of preemies aren't ready for 100% breast until their approx. due date.

Obviously feed on demand. Feed until she stops, but IMO, don't try to force her to continue. Rest is really important, just as important as food. Actually, 0.5oz sounds like a good session to me (for a 35 weeker at 37weeks). That tiny tummy might really be filling up on 0.5oz. Think in terms of daily intake, not per session. Assuming the babe is still really sleepy, I would not wake the babe more often than every 3 hours to nurse. This will give her time to re-coup her strength before the next session.

How are the bilirubin levels? Jaundice makes babies even more lethargic. Refusing to suck may also be an ear infection?

ETA: Just replace the word bottle in my post with whatever alternative you want to use: SNS, Lact-aid, cup, finger, syringe.
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Old 09-11-2006, 05:49 PM
 
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I also meant to ask if latch issues are a problem? Have you tried nipple shields? They may help her efficency at the nursing sesions.

Some baby's not so much, they did wonders for mine.
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Old 09-11-2006, 09:08 PM - Thread Starter
 
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Thank you for the responses. Just a little update: I went over about 3:30. She had finished a feeding shortly before I got there. She nursed at 5 for about 20 min. and brought in an oz. More than ever before from her mom. Hurray! Then she took a bottle and drank almost 2 oz. She was very alert for an hour after feeding. I don't know why she was refusing earlier today. I definately think she could be very tired from getting woke up every 2 hours. Maybe she just wanted a break. Anyways, thanks for the tips about the preemie forum. I'll keep you posted. If you think of anything else, please let me know. Oh and she hasn't shown any sign of nipple confusion!
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Old 09-11-2006, 09:27 PM
 
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Yay! I'm glad to hear things seem to be improving.

We worked hard with an IBCLC who specialized in preemies in order to get onto full time nursing but it was so worth it! Its hard with a preemie because sometimes the things they need are so very different from full term babies (i.e. longer breaks between nursing sessions vs. lots of short feeds) and therefore counter intuitive.
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Old 09-11-2006, 10:36 PM
 
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I've gone through this, too-including the spaghetti strings, with my son Caleb-now 15yrs old. My baby was a preemie as well,born at 34 weeks. I didn't have him with me.

The nipple shield worked well when he started nursing at 2 weeks. I pumped and pumped, too. The more he nursed, the better it was, even though my nipples were very, very sore, cracked and bleeding. It was worth it. Have her put lots of lanolin on, too. Also eat yogurt(plain), and put a dab of yogurt in the baby's mouth every time she nurses, to avoid thrush. It really works. I went through it for months. It WILL get better.
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Old 09-13-2006, 01:56 AM
 
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Quote:
Originally Posted by hlivengo
Also eat yogurt(plain), and put a dab of yogurt in the baby's mouth every time she nurses, to avoid thrush. It really works. I went through it for months. It WILL get better.
This may be a silly question, but can't this produce a milk allergy? I thought it was best to stay off of milk products till 1 year? Sorry, I am just learning.

Also, the opening poster states the oz that the baby drinks by breast. How can she tell this?

Thanks!
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Old 09-13-2006, 09:12 AM
 
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According to the Drs, the benefits outweigh the risks. It isn't as if you're pumping the stuff into them, though by 9 months my ds had about a teaspoon a day. He's got no milk allergies! He had much antibiotics by then, and was very sickly in the beginning, with pneumonia-even needing spinal taps, ear infections, etc. I believe the yogurt helped in that I was able to help keep the thrush away, and was able to eventually successfully nurse him for a year and a half. He's 15 now.

I'm actually doing it again right now with my nearly 3 month old, as he developed thrush and a yeast diaper rash. It definitely works!
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Old 09-13-2006, 10:20 AM
 
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I had a 35 week-old preemie with a lot of sleepiness, and she also got dehydrated. What saved our nursing relationship was an SNS (by Medela). You could also look into a lact-aid. I *understand* the theory of keeping the bottles and that a preemie might not be ready to BF 100%. I understand that BF'ing is work and wears them out. Even in our case, the docs thought that my baby was literally burning more calories by nursing than she was taking in. But an SNS or Lact-Aid will give the supplement while still at the breast. Plus the baby will learn how to nurse (use the medium or small sized tubing on the SNS) and above all, she will equate the breast with satisfaction and full-ness. The best thing to use in the SNS is breastmilk, however, if there is not enough BM to pump, then if you have to, use formula. But an SNS can save the nursing relationship.
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Old 09-13-2006, 11:18 PM - Thread Starter
 
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MarcyC - thank you for this! I just brought it up to my SIL today. The baby really isn't taking the breast well and is getting better at the bottle. She didn't understand why she should bother, but I told her the SNS could save her nursing relationship. I will pass your quote onto her.

To the poster who wanted to know about yogurt and milk allergies, the amount ingested by the baby would be incredibly small. I believe you put in on after nursing and it will be absorbed by the time the next feeding comes around. Also, the culturing of the yogurt changes it so that it's very different from milk. You can give babies yogurt much earlier than you can milk.

Also, the way we knew oz of breastmilk was with a scale! We weighed the baby before the feeding and after. It is important to leave the diaper on so that any poop or pee that happens during the feeding are still weighed. (They would have been in the baby's system before and we are just looking for the amount taken in.) I hope that makes sense.
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Old 09-13-2006, 11:32 PM
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Hey - sorry to hear about your SIL having a hard time s

My son Julian was 36 weeks. He was an AWFUL nurser at first. I had to wake him every hour, because he was so sleepy he wouldn't wake to eat, and if he went more than an hour without eating, he wouldn't eat, he would be very weak. I got mastitis also (I have oversupply issues), and had to take antibiotics. I gave Julian probiotics, I just opened a capsule, and dipped my finger into the powder and put it into his mouth. I also took probiotics myself.

About 4 days after he was born, he complete refused to nurse, I finally called an LC and she came over and I pumped and fed Julian with a syringe ust to give him some energy, and give me some relief.

If I can emphasize anything here it would be to feed the baby VERY often. Wake the baby every hour. Babies born this early are supposed to be getting "room service", so to speak. Nursing is a lot of work, they get sleepy, but if they aren't eating every hour or so they will get too weak to eat.

I hope things start getting easier for her.

s
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Old 09-14-2006, 06:56 PM
 
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Quote:
Originally Posted by BornInSeptember
This may be a silly question, but can't this produce a milk allergy? I thought it was best to stay off of milk products till 1 year? Sorry, I am just learning.

Also, the opening poster states the oz that the baby drinks by breast. How can she tell this?

Thanks!
Just chiming back in to say that my son does have a milk allergy and we buy pediadophilous its powdered acidophilous that is milk free. But from an allergy stand point if you(mom) drink milk then baby is already exposed to cow milk protiens via the breast milk and a small amount of additional ingestion of yogurt probably would make no difference.

To the OP
I hope things continue to work out for you SIL and she continues to BF may be you could show her this thread and tell her we're all rooting for them! So many of us have had our share of dificulties but in the llng run they seem small in comparison to the totality of a nursing relationship!

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Old 09-14-2006, 07:55 PM
 
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Thanks for clearing up those questions I had them too. I didn't have access to a scale for every feeding . That must be a very nice tool to reassure a new mom.
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Old 09-17-2006, 04:12 AM
 
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In the NICU we weren't allowed to bf more than 15 min. until they were two weeks old. Anything longer than this and they were just buring too many calories. Did the baby have to stay in the hospital at all? With gavage feedings, our two were getting 5 ccs every 3 hours and worked their way up to 38 cc (just over an oz) every 3 hours. It is important to let the baby sleep, but also to make sure they eat frequently. Every two to three hours is necessary to make sure the baby gains. Cup feedings are one way to avoid nipple confusion and are becoming very popular in hospitals. We started bottles at 2 weeks and have had no nipple confusion. In fact, they both prefer me! I know this isn't a popular view, but I don't think bottles are a huge problem at least for some babies. Also, she needs to pump every 2 hours during the day and then can go 6 hours at night without. This will take care of the mastitis and also the low milk supply.
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