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Thread: jaundiced premie latching/interest problem- long

  1. #1

    Default jaundiced premie latching/interest problem- long

    I can't thank you enough for any advice you can offer me. I am a first time mom home just a few days with my DS. I am bound and determined that he will be breastfed, but I am getting very frustrated in my attempts. He was born this past weekend (so is on day 6 now I believe) and was born at 36 weeks and 2 days.

    He hasnt fed well from day one. He doesn't want to open wide to latch and when he does latch well he quickly gives up on suckling. By the time we left the hospital this past Monday he was starting to latch a bit better and suckle for a few minutes on one breast (loses interest by the second one.), but I was pumping colostrum and feeding that to him out of a cup to supplement.

    When we arrived home he quickly improved, and by Tuesday morning he was suckling at least half-heartedly on both breasts for 10 minutes each. Unfortunately, he regressed precipitously with the onset of jaundice. His level of bilirubin was as high as 16.6 on Wednesday and he became super lethargic. He absolutely would not wake up to breastfeed despite our extreme measures: stripping him naked, bathing him all over with wet washcloth, sitting him up and bouncing him, and moving his arms around. We were still able to feed him out of a little medicine cup, and since my milk came in on Tuesday he is getting increasing amounts of food- all by cup except for maybe one suckle or two from each breast- of around 1-1.5 oz every 2.5 hours or so.

    My routine consists of offering each breast to him for 15 minutes - which is laughable because he has next to no interest in it at all- then pumping for 10 minutes per breast and then feeding him out of a cup for the next 45 minutes. Then repeating the whole thing 1 hr 30 minutes or 1 hr 15 minutes later. It is becoming very frustrating that he refuses to suckle on the breast but then he will fuss while I pump because he is hungry! He actually seems to get angry when I offer him the breast if he is fussy- he much prefers the cup!

    One thing I have noticed now that his bilirubin levels are dropping is that he doesn't seem to get his tongue underneath the nipple appropriately. When I give him my finger to suckle, his tongue wants to stay at the back of the mouth. I can encourage it to drop to the bottom of his mouth with my finger and when I do, he sucks quite strongly and continuously. It is significantly stronger than I ever feel him do on my breasts.

    So, my questions are multiple-

    1)Is there any way I can encourage him to put forth the effort necessary to breastfeed- especially to open wide for a good latch and to continuously suckle past just 2 or 3 pulls? He obstinately refuses to open wide for a good latch- and I assume it is because he doesn't feel it is worth the effort to breastfeed.
    2) How do I ensure that his tongue is below my nipple to get good suction?
    3) Is it possible that he isn't putting forth the effort to breastfeed because he knows he is going to get his feeding out of a cup? We didn't want problems with nipple confusion, but now it seems we have ended up with the same result- a baby that is too lazy to breastfeed. If so, what alternatives do we have to get his nutrition in him without worrying that it is going to interfere with his breastfeeding?
    4) Do you think these problems will resolve themselves when his bilirubin levels come down enough that he is no longer lethargic? Because of the jaundice I cannot risk letting him go without food for any length of time, so I can't just wait until he is super hungry before I offer him the breast. And at times it is clear that he is very hungry but that he doesn't understand how to feed himself from the breasts.
    Thank you so much for any help you can offer- I feel powerless and incredibly frustrated!

    I anxiously await your advice!

  2. #2
    Join Date
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    Default Re: jaundiced premie latching/interest problem- long

    Congratulations on your little one! I don't have ANY experience that would be helpful for you, unfortunately, but your situation sounds like one that might benefit the most from hands-on experienced help. Do you have access to an IBCLC?
    Teal

    25 May 96 and 14 January 08 and 27 February 2012

  3. #3
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    Default Re: jaundiced premie latching/interest problem- long

    I agree the the PP that hands on help would be good- espcially since your LO is a premie. One thing that I was thinking you could do is start to pump just until your milk lets down then latch your LO on- that way he gets the instant gratification of the milk without much work
    Jessica

    Moma to DS1-the monkinroanie (3/09) and DS2-the sweet pumpkin (5/12)
    Strong Women- May we have the delight of knowing them, the courage to be them and the privilege of raising them.
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  4. #4
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    Default Re: jaundiced premie latching/interest problem- long

    I agree with getting some hands on help.

    And the trick we did for the tongue was right before he would latch, my LC taught me to kind of sweep down from his lip to his chin, making him open his mouth wider, which pulls the tongue down and forward. That way we would get a better, more productive latch.

    As far as the effort, I think it can be just normal that new babies are sleepy, lazy eaters, especially preemies. Are you doing kangaroo care at all? I kept my son on my chest just about 24/7. It really really REALLY helps.

    Good luck mama!!!
    I'm Hillary
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  5. #5
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    Default Re: jaundiced premie latching/interest problem- long

    I'm sorry that you're having trouble. I never had a pre-term one myself, but I've had (what I view as) my share of trouble with latching and sucking, and I know it's hard.

    It sounds like you're doing things well so far in that you're pumping and feeding your LO via cup when he needs supplementation. I know it seems that he's prefering that to your breasts, but it's still far better than a bottle in your situation, I think.

    It sounds like your supply is fine for his needs, but I'd definitely keep up the measure to ensure that it stays strong. Having a good supply is one of the factors that encourages babies to come to and stay at the breast.

    Are you familiar with using a supplemental nursing system? It's a bit of a pain, but the benefit is that your breasts get added stimulation while your feeding, and it can help to make the breasts a pleasant (rather than frustrating) place to be for the little one. It was probably the single most useful tool for me in getting a successful breastfeeding relationship established with my second (the scale was the most reassuring tool in the process eventually).

    I do agree with the previous poster that this sounds like an excellent time for a consultation with a lactation consultant. My second one had problems sucking (I often noticed his tongue on top, so that rang a real bell in my head, but he had problems even when it was underneath). When we tried finger feeding him with an SNS it took him 40 minutes to get one ounce. The LC's diagnosed him with a disorganized suck. We tried various measures, but one (besides time and practice) that helped a lot was getting him seen by a chiropractor. His parietal bones were overlapping his forehead (and presumably causing a headache that made sucking unpleasant). When they started massaging the bones, he downed a 4 oz bottle in 30 minutes (about 4 times faster than previous sucking) and was willing to come back to the breast after a period of refusal. I don't know that there's anything like that going on with your son, but it would be worth asking.

    Lots of babies (especially pre-term ones) just need some time to master latching. If you can keep up what you're doing and give him lots of pleasant time at the breasts (even if it doesn't involve nursing), you're doing a wonderful thing. It's just hard when you don't know whether it will work, but it just might. My second started nursing (really nursing) around 2 months and only mastered it at 4 months. He's still doing great at 17 months.

    I hope this helps encourage you that it's not impossible (just hard!). I wish you both very well.
    I breast milk fed my Blossom for fifteen months (after exclusively pumping for thirteen). My Bud (nineteen months) is still nursing directly (after a rough start that included a few months of pumping and supplementing with mommy's milk).

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  6. #6

    Default Re: jaundiced premie latching/interest problem- long

    Thanks for the advice folks. I called a lactation consultant today and she had some fabulous advice. She recommend that I shorten the time I offer the breasts to a more vigorous 5 minutes each while I lengthen the time I spend pumping to 15 minutes per breast.
    She also recommended that since he has become accustomed to the cup, I should switch to a bottle for my supplementary feedings. I was happy to hear this since it takes a whole lot less effort than feeding out of a cup, plus th poor guy was getting red at the corners of his mouth from the sharp edges of the cup.
    Along with these recommendations, I am implementing a rapid boob-switching technique so that he doesnt get bored with one. This seemed to work very well and I just had our most successful BF in three days!! Yippee!
    Again, thanks for all the advice. I am feeling hopeful again that this can work for us!!

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