Breastfeeding Chronicles: Setback -- Refusal of breast, possible forceful letdown and maybe reflux?


Yesterday we went to the Lactation Consultant -- and learned that four days of exclusively breastfeeding was not enough. She only gained 2.3 ounces for an average of 1/2 an ounce a day. This is the low end of what's acceptable. So now I had to make an appointment with the pediatrician for next Monday - xmas eve. AND I have to go back to the LC on the 2nd which the wretched plan of using the supplemental nursing system. That's the jug hanging from your neck with tiny little tubes taped to your nipples that lets a steady flow while you nurse.

I was devastated. Hurt. She said "Maybe she's crying because she is hungry." She doesn't believe me when I say she is gassy or has a rumbly tummy and whenever it's like that she doesn't eat much. In fact she has a bad night and cried most of it -- as well as the morning. Her tummy didn't lie. She didn't want to nurse. What am I supposed to do?

Well apparently now I am supposed to offer a bottle. Great. Bottles are supposed to decrease milk supply - everyone and their brother warns of using a bottle for supplement (and I am referring to bottled breastmilk). Except for ... well, I will et to that in a second.

I went home and cried. The neighbor came and caught me in a fit and suggested that the doctors and LC aren't supportive enough. It would seem that is the case. I mean, I thought the whole purpose was to get Morella to breastfeed from both sides and now that she was I am supposed to use a bottle? When did the focus shift to weight gain? How much is enough? When am I going to be done with them?

I decided maybe I should call the La Leche League people and so I went online to look and noticed that they were having their meeting on Monday night instead of Wednesday like I had thought. I asked Hilary if she wanted to go -- nope. I asked Tim and he said no. I thought about going myself because Morella was coming up on 3 hours of sleeping and I was going to try and feed her before we got there.

No go. She didn't want to eat. She was fussy. So finally I packed her up and we went. I could barely keep it together. While we were there and the leaders asked if any of us had questions or issues, I raised my hand and broke down -- managing to get most of my sad tale out. The women WERE very supportive.

They watched Morella eat and tried to help with a cradle position (I can't do it yet) and said I might have a forceful or fast letdown. I would believe it. Morella often seems like she is choking and gulping, and I suspect she has a weak suck. She doesn't have to work that hard to get milk to come out.

Long story short - they suggested letting the foremilk run off because it's probably the cause of gassiness and fussiness, and after the initial flow is over let her drink more of the hindmilk. Nurse her longer on one breast...which I had been trying to do. They said they would follow up with some links -- which they did.

"When a mother has more milk than her baby can handle, the following behaviors may be common:

* Baby cries a lot, and is often very irritable and/or restless
* Baby may sometimes gulp, choke, sputter, or cough during feedings at breast
* Baby may seem to bite or clamp down on the nipple while feeding
* Milk sprays when baby comes off, especially at the beginning of a feeding
* Mother may have sore nipples
* Baby may arch and hold himself very stiffly, sometimes screaming
* Feedings often seem like battles, with baby nursing fitfully on and off
* Feedings may be short, lasting only 5 or 10 minutes total
* Baby may seem to have a "love-hate" relationship with the breast
* Baby may burp or pass gas frequently between feedings, tending to spit up a lot
* Baby may have green, watery or foamy, explosive stools
* Mother's breasts feel very full most of the time
* Mother may have frequent plugged ducts, which can sometimes lead to mastitis (breast infection)"

I went home, she nursed great last night and was in bed by 10.30 and up at 3.30 to eat and ate normally. Then starting this morning she wanted nothing to do with me. She wouldn't latch and when she did -- sort of -- she was bite down with her gums, suck and but wouldn't swallow and then scream. The same was true for both sides. Finally, Tim made a bottle before leaving and she took ... well a long time to drink it. She takes forever to drink these bottles, but as the day progressed she still refuses me.

I did get her to nurse for about 5 minutes on each breast at separate times -- lots of gulping, choking -- and then eventually crying and complete refusal.

My plan has been to offer her the breast every 2-3 hours for 20-30 minutes (time included for soothing her to get her calm enough to start again). And then offer the bottle and pump (not easy when it's just me at home).

She has been able to deal with this fast let down before. Why is she refusing me today? I feel so frustrated and helpless with this whole situation. I need someone to talk to about it on daily basis if I need be.

I was reading the Nursing Mother's Companion which says:

"Some breastfed babies can suffer painful reflux. Symptoms of this problam can include sudden or inconsolable crying, arching during feedings, refusing the breast or bottle, frequent burping or hiccoughing, bad breath, gagging or choking, frequent throat inflammation, poor sleep patterns, slow weight gain, frequent ear infections and less commonly, respiratory problems -- wheezing, labored breathing, asthma, bronchitis, pneumonia and apnea. "

and in collaboration with a suggestion that she might have reflux I found internet research to say:

“Scrawny Screamers,” on the other hand, show symptoms such as irritability, excessive fussiness, swallowing difficulties and poor weight gain. They seem to have painful regurgitation instead of the effortless spitting up that is typical of newborns. Many also exhibit poor feeding and sucking skills. They sometimes have breathing problems as well, stemming from fluids such as milk or acid being sucked into their lungs during reflux episodes. These are the babies that should be tested for GER."

and

What are the worrisome symptoms of gastroesophageal reflux?

In a small number of babies, gastroesophageal reflux may result in symptoms that are concerning. These include problems such as:

* Poor growth due to an inability to hold down enough food
* Irritability or feeding refusal due to pain
* Blood loss from acid burning the esophagus
* Breathing problems

and

There are many different symptoms of GER. Your child may only have a few of these symptoms. The most common symptoms include:

o pain, irritability, constant or sudden crying, "colic"
o frequent spitting-up or vomiting
o vomiting or spitting-up more than one hour after eating
o not outgrowing the spitting-up stage
o refusing food or accepting only a few bites besides being hungry
o poor sleep habits, frequent waking
o "wet burp" or "wet hiccup" sounds
o bad breath

The less common symptoms of pediatric GER include:

o constant eating and drinking (to soothe a sore throat)
o intolerance of certain foods
o poor weight gain; weight loss
o swallowing problems, gagging, choking
o hoarse voice
o frequent red, sore throat
o respiratory problems; pneumonia, bronchitis, wheezing, asthma, nighttime cough, apnea, aspiration, noisy or labored breathing
o ear infections
o constantly running nose; sinus infections
o tooth enamel erosion
o excessive salvation, drooling
o peculiar neck arching, Sandifer's Syndrome


If you think your child may have GER, please contact your child's doctor. It is also very important to let your doctor know if your child develops new symptoms or if the symptoms change.

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Morella does have breathing problems -- she's wheezy a lot of the time, she gets hiccups a lot, she sounds like she has a frog in her throat most of the time, and she has sounded hoarse many a time -- all things I attributed to long bouts of screaming or normal babiness.

Maybe it's a combination of reflux and a forceful letdown. I don't freaking know. I do know I am worried about it being reflux and we have to go through Monday before getting to see the pediatrician about this. That is five more days of this -- what if she continues to refuse the breast? What if I have to keep pumping every 2-3 hours?

I am fully able to admit that I need help right now with this. I need someone to be able to talk to about this. I am ready to give up and quit.

I am remaining calm about this today -- or trying to. I am waiting for Tim to come home so that I can at least take a shower. Except now he just called to say that he's gonna be late.

I just wish I had answers to this. This week will be four weeks -- and so far it isn't getting easier. It's just getting more complicated.

Edited to add:

Tim seems to think I am worrying excessively. Maybe he is right. He says she is just having that kind of day. She is inconsistent. She is have a bottle day. She is gaining weight, is healthy and he just doesn't think that reflux is the case. I am letting this weight gaining thing hang over my head.

Maybe he is right. I can't seem to get perspective on this right now. I need an adopt a Mom or something to help and give the support I need.