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Thread: Help! Lazy Eater

  1. #1

    Default Help! Lazy Eater

    I'm looking for some suggestions as I really feel like I'm out of options.

    My baby is just over 3weeks old and we breastfed exclusively for the first 2.5 weeks, until we had a weight check and she had lost weight:
    Birth weight: 6lbs12oz
    Weight @ 3days old: 6lbs 3oz
    Weight @ 2weeks old: 6lbs 7oz
    Weight @ 2.5 weeks old: 6lbs 3oz

    So her pediatrician and the lactation consultant told me to offer her bottles /SNS after each nursing session (or during if using SNS), offering expressed breastmilk if I had it, or formula if I didn't. They also told me to pump about 3 or 4 times a day after I nurse her, to take "More Milk Plus" supplements, keep hydrated, get rest etc.
    Since then she has rapidly started to gain weight - she gained 7oz in 3 days. The issue is that when I nurse her she nurses for a LONG time, but she doesn't seem to be efficiently emptying the breast. She only swallows after every three or four sucks, then will just do gentle sucks and nor swallow, or will not suck at all but will stay latched. She can literally nurse for an hour, then when she finally un-latches she screams, roots, sucks on her hands and will take a 3oz bottle (which is almost always formula, because when pump I don't get anywhere near enough to give her 3oz extra for every feed).
    FYI I have a medela double electric pump.

    I'm completely exhausted. Because it takes so long to feed her (it can be 2 hours by the time I nurse, bottle feed and pump) that is all I do, all day. I'm so frustrated because she is getting so much formula. I tried doing SNS to cut down on the time it takes to feed, but she fusses so badly with the tube, and then gets really bad at sucking when I get he tube in the correct spot. It really isn't working for us.

    Any other suggestions? I so badly want to continue to breast feed, but I'm feeling like its a waste of time right now.

  2. #2
    Join Date
    Jun 2009

    Default Re: Help! Lazy Eater

    When the baby gained 7 ounces in 3 days, HOW many ounces of supplement was baby getting? 7 ounces in three days is an extremely fast weight gain. Twice what is normal. And no, this cannot be entirely explained by baby needing to ‘catch up.”

    Was the 2 week and 2.5 week weight check on the same scale? How were/are output (stools) over the time baby was not gaining/losing weight?

    What kind of pump are you using? have you ever tried hand expression before or after pumping?

    Did the IBCLC observe a nursing session? Did she make latch suggestions, show you how to do breast compressions? Did she do a before and after nursing weight check? Is the suspected issue poor milk transfer or low production, or both? And how was this ascertained?

    I am asking all this because you were given an awful lot of interventions, and there is no way from here to tell which ones were needed or targeted the actual issue. If the issue was low milk production and that was solved with the galactagogues and the pumping, then you might be able to stop pumping. If the issue was poor milk transfer, an sns might not be the best tool. Baby needs to be nursing effectively for the sns to work, is my understanding. IN any case, an SNS will not solve poor milk transfer if that is the problem. Things change very fast in the early days, and there should have been followup with the IBCLC for reassessing the situation. Was this offered to you?

    hang in there, baby is gaining well now and that is excellent news. But I do suggest, call your doctor and/or IBCLC asap and get another consult. Tell them this treadmill you are on is not working for you, that baby is gaining great but you are exhausted. Ask for a new plan. Your baby is gaining well now so everyone can perhaps take a step back and approach the issue more calmly and with better targeting of the actual issues.

    A three week old baby needing to nurse almost all the time is normal. As long as baby is gaining at the breast, this is not even indicative of a problem. Long nursing sessions without appropriate gain may indicate an issue.

    All mothers of three week old babies are exhausted, but your extreme exhaustion is in large part to all the other things you are doing- the pumping, bottles etc, not just baby nursing a long time.

  3. #3

    Default Re: Help! Lazy Eater

    Sorry for the delay in responding, I was having log in issues.
    I'll try to answer all of your questions.

    I'm using a medela pump in style pump. I have watched the Stanford video on increasing production with compression and hand expression and have tried it, but once I'm done pumping I can't get any more milk out.
    My LO was taking about a 2oz bottle after nursing, at each feeding when she gained the 7oz. I don't know how much she has gained in the last few days as I'm not scheduled for a weight check until this coming Thursday. On that day I have another consult with the LC.
    The LC did observe a nursing session and didn't see any issues with the latch or positioning. She did NOT check my LOs weight before and after.
    They suggested that I offer bottles after each nursing session, and they suggested offering 1/2 to 1 oz. I did that but my LO was still hungry so I offered more and she took it (up to about 2 oz if she has nursed first, and she will take 3 to 3.5 oz if she doesn't nurse first).
    Stools and wet diapers have been ok, although when she was loosing weight they were very small.

    The Dr and Lc weren't sure what the issue was but it just seems to me that she does not nurse effectively (this was kind of confirmed once I saw how she didn't pull anything out of the SNS). Also, like I said before, when she is nursing she sucks many times before swallowing, then stays latched without sucking, then will do shallow sucks and not swallow. I compress my breast as she nurses, and I have tried the reflex point on her neck. I will even unlatch her, burp her and try again, but even then she is only aggressive for the first few sucks then she goes back to her "lazy" nursing. Even when she has nursed for a long time, and she falls asleep, unlatches and has a floppy arm, as soon as she wakes a little she starts frantically rooting and stuffing her fist in her mouth.

    I will call the LC tomorrow and see if she can see us sooner than Thursday and try to get a better plan in place. She had suggested the SNS last week when I was there because I had explained how exhausting it was to do the nurse, bottle, pump routine. Since then I have tried SNS multiple times but just can't get it to work. My LO will not latch if I hold the tube on my breast as she tries to latch, so I have tried to ease the tube into the corner of her mouth once she is latched, but even when I do manage to get it into her mouth she just doesn't suck anything out of it, and more often than not she just gets fussy and pulls off the breast.
    One other thing I have noticed today is that she is even a slow eater when feeding from a bottle. I am using Dr Browns bottles and started with Level 1 nipples, but they were so fast for her that she was spitting up a lot. I bought some preemie nipples and while she is doing much better ( in that she rarely spits up with them) she sucks really slowly, and seems to fall asleep easily even when having a bottle.

  4. #4
    Join Date
    Jun 2009

    Default Re: Help! Lazy Eater

    baby not being able to get milk out with an SNS means baby could not get anything out with the SNS. No more, no less. SNS is not the only lactation aid also. have you tried taping the tube or inserting it after baby latches? More on lactation aids below.

    Baby wanting more from a bottle or taking a certain amount from a bottle does not mean anything.

    How many times a 24 hour day does baby nurse?
    Are sessions limited in any way by you, in frequency or length (I dont mean, do you unlatch to use the bathroom sometimes, I mean, are you nursing for 10 minutes and then unlatching baby. That kind of thing.)

    When baby wakes and sucks her fist, do you nurse again? If baby fusses after the one ounce of supplement it was suggested you do per feeding, do you try offering the breast again?

    Does baby suck on a pacifier or is baby ever swaddled?

    If you think the problem is poor sucking ability, that is somethign you want to bring up to the IBCLC.

    More on lactation aids:

    http://cwgenna.com/smartnothard.html (also discusses sucking behavior briefly)



  5. #5
    Join Date
    May 2006

    Default Re: Help! Lazy Eater

    It sounds like the baby has a really gentle feeding style, yes? Usually a latch that feels good is good- but in this case you have a latch that feels good but doesn't seem to pull out a lot of milk? If you're in pain, that would really change the picture.

  6. #6

    Default Re: Help! Lazy Eater

    Baby nurses about every 2-3hours during the day. She sleeps for a longer spell at night, so then she may go 4-5hours.
    The only limitation on her nursing is when she falls asleep and stops sucking and I can't get her started again, then I will un latch her and try to wake her and get her interested again - if I don't we would sit there 24/7 with her doing nothing other than using me as a pacifier. If she has eaten for about 20-30 minutes on each side and seems to have eaten well then I don't mess with her too much.

    I have both taped the SNS tube and tried inserting it after she has latched....but with no success. She makes a face and pulls off.

    I have not been offering the breast again after the one oz bottle, so I will try that next feed. It never crossed my mind to try that.

    She does take a pacifier when she's tired and needs to settle herself. And she does get swaddled when she is tired and while sleeping, but I un swaddle her to feed her.

    Mommal, I'm not in pain when she latches, although I do have cracks from a few weeks ago that haven't yet healed, so I'm now wondering if there is an issue. She seems to have a strong suck when she decides to suck....it's getting her to suck and keep doing it that is the issue.

  7. #7
    Join Date
    Jun 2009

    Default Re: Help! Lazy Eater

    If a baby is not getting enough breastmilk, there are 3 possible overall causes. And of course, sometimes there is a combination of causes.

    1) baby cannot transfer milk well. This is what you suspect-the lazy suck.
    2) Mom does not make enough milk
    3) baby is not nursing frequently enough and/or long enough.

    3 is the most overlooked possibility but is actually very common, especially when a baby is the ‘undemanding’ sort.

    Many moms cue feed as they are told to do, never realizing that their baby may not cue often enough! In those cases, it is important to also offer/gently encourage baby to nurse as much as possible.

    Baby nurses about every 2-3hours during the day. She sleeps for a longer spell at night, so then she may go 4-5hours
    I know it may be hard to go back and figure this, but it important (when there are weight gain issues) to have a clear idea how many times in 24 hours baby nurses. it may help to get a piece of paper, right a start time and date on it, and make a check mark every time baby nurses.

    If a baby is nursing every 3 hours for 24 hours, that amounts to 9 nursing sessions. If a baby nurses ever 2 hours for the entire 24 hours, that amounts to 12. 9 is going to be too infrequent for some babies! 12 or sometimes, even more times is more typical.

    The ‘longer’ sleep stretch is not necessarily a problem, assuming baby is nursing very frequently-at least every 2 hours or really, MORE often, the rest of the day. Most babies do nurse in a pattern where they nurse very frequently-more than once an hour, even, for part of the day- and take longer stretches here and there. This is called 'cluster feeding.'

    The difference between 9 times and 12 times is 3 nursing sessions, 4-6 ounces total, and quite possibly, whether a baby gains or not. So, it is important.

    The general breastfeeding advice is that all sucking be at the breast. Baby is SUPPOSED to use you as a pacifier. That is how baby is designed to get enough milk and get moms milk production where it is supposed to be, and keep it there. I know it feels like all you do is feed your baby. Well, it is kind of supposed to feel like that in the early weeks!

    Pacifier use is cautioned against by many breastfeeding experts because it has been shown to cause poor weight gain in some babies. Using them (except for emergencies, like in the car) is best attempted only after about 6 weeks when milk production is well established. They are best avoided as much as possible when there are weight gain issues.

    Swaddling may have the same effect, in theory, because swaddling is intended to 'help' a baby sleep longer. Which might mean, right through infants feeding cues. The connection between swaddling and slow weight gain has been written about by Nancy Morhrbacher, a highly respected breastfeeding expert.

    I have no idea if nursing frequency is playing a role in your baby’s slow weight gain, but it is something to consider. It’s certainly the easiest 'problem' to fix!

  8. #8
    Join Date
    May 2006

    Default Re: Help! Lazy Eater

    with LLLMeg. Would you be willing to take away the pacifier and the swaddle right now, while you get nursing on track?

    Unhealed cracks may point to a latch issue. A poor latch can cause difficulty with milk transfer. Can you describe the cracks a bit more, and also tell us what shape your nipples are when they come out of baby's mouth? Are they symmetrical, like pencil erasers, or asymmetrical/wedged/creased/ridged/pinched/flattened/shaped like new lipsticks?

  9. #9

    Default Re: Help! Lazy Eater

    Without sounding ungrateful for your advice I'm at a loss as to how to feed her every two hours. She nurses for an hour or 1.5 hours. When would I sleep? She doesn't settle right after a feed.
    We don't use the pacifier often, so I'm happy to forgo using it. I'm less eager to stop swaddling as it really does soothe her. I could try to un swaddle her once she is asleep, so she doesn't sleep past a natural feeding time.

  10. #10

    Default Re: Help! Lazy Eater

    The cracks extend from one side to the other. I've been using Newmans nipple ointment so sometimes they seem to heal but one right back if baby is a little rough.
    I've noticed that when we do have a good feeding session, where baby seems to be sucking well, then the nipple comes out symmetrical. When we have a bad session they come out creased, and the crease is the same direction as the crack.
    The other thing baby does is that, while still latched, she pulls her head back and stretches the nipple like a rubber band. I try to stop her, but she does it o quickly that most times I can't stop her from doing this. I'm wondering if she is trying to get more milk when she does this because this is often the time she ones off the breast but is still rooting.

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