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Thread: Fussy baby with latching issues - Please HELP

  1. #1

    Default Fussy baby with latching issues - Please HELP

    This is going to be a long one. But I need help, and I'm running out of places to look.

    My daughter will be 15 weeks tomorrow. Breastfeeding has been a struggle since day 1. She has been fussy almost always, some days are worse than others. Lately, she's been ending nursing sessions crying (and now so am I). And it has always hurt. Nipple shields are the only reason we've made it this far. I nursed my son for a year, and dealt with some nipple confusion early on, but we got past it and had a mostly pleasant year of nursing. This time around was supposed to be easier.

    VBAC (woot!) for my daughter, and breastfeeding was painful from the beginning. Two hospital lacation consultants said the latch looked. In fact, at no point has the latch not looked good, at least from the outside. We came home, and it still hurt. We also had lots of spitup and coughing/choking. Called lactation consultant (LC) #1 which also happens to be the leader of my local LLL support group. She diagnosed oversupply and a lip tie, maybe a tongue tie. Fed one side per feeding, and put baby in a more upright position, but it still hurt. Had a frenectomy done for the lip and tongue tie. Things didn't get better. Wait it out was the suggestion from LC1 and the LLL group. Waited, no improvement. Started using nipple shields (had from kid #1). It hurt less, but still hurt. LC1 suggested another LC. LC2 suggested I still had oversupply issues. She suggested magnesium (which gave me stomach issues), avoding gluten and soy (which I more or less do), laid back nursing (which results in angry baby and even more nipple soreness), and additional burping (which also results in angry baby because we stop). Nothing has helped, and in most cases, made things worse. I'm now block feeding offering only one breast per feeding. I get about 5 minutes of peaceful nursing before the wrestling match starts. I try to get her to nurse for at least 20 minutes, unless she starts crying, most usually hit the 30 minute mark. We nurse roughly every 3 hours (Baby Whisperer 3 hour EASY schedule. I go back to work in a month so I'm trying to get a routine going). If she ended the last session crying, I'll nurse her again before her nap. We had tears Sunday at 10am, Tuesday 4pm, Wednesday 10am and 1pm, today 10am. So the fussiness seems to peak during the day. Also, the least painful position is the football hold. Anything else hurts even more.

    We did stop using the pacifier for sleep on Monday, so that may be contributing to something right now. But she has almost always been fussy and it has always been painful. Outside of nursing, she's a happy baby. She was 6lbs3oz at birth, and now she's around 11lbs. I'm getting 2-3 bms a day. I usually change her every 1.5 hours, and most of the time those diapers are wet. I have a call out to my pediatrician about potentially seeing a chiropractor. I'm against crainosacral therapy only because the only positive information provided about it is from the organization that created it, and that's not enough for me to trust it.

    Is there anything else that could be wrong? Anything else that could offer a solution? This is just so incredibly frustrating. I break down in tears more often than I care to admit, especially since she's started her tearful sessions. I just don't know how much longer I can keep this up. The only thing keeping me from giving up is that formula is so expensive. I'm still working with LC2, but I don't feel like we're getting anywhere. I even tried getting a third LC, but she wasn't accepting new patients and recommended LC2.

    Edit: I just changed her diaper. BM #3 and it was definitely more green than yellow. So she's probably not getting enough hind milk now. Fabulous.
    Last edited by @llli*kellyleia; July 21st, 2016 at 09:59 AM. Reason: Additional info

  2. #2
    Join Date
    Jun 2009

    Default Re: Fussy baby with latching issues - Please HELP

    Hi kellyleia. I think it would help at this point to prioritize the issues, because your treatment (imo) has been a bit all over the place.

    1) Nursing hurts. To me this is the single most serious issue. Some babies are just fussier than others. I am not saying your baby might not have some issue, and it is possible the issue is something related to breastfeeding. But that is not a for sure thing. What is for sure is that painful nursing is most certainly related to breastfeeding. So that is what I would suggest dealing with first.

    So, why does nursing usually hurt? The vast majority of the time, it is due to issues with latch. These are not always visible and a latch will often look fine and still not be right. In my opinion, what you and your helpers should be concentrating on now is adjusting latch and positioning. Cranial sacral may not help, but it certainly cannot hurt. Some practitioners will do babies for free, so it may be worth a look if your IBCLCs are suggesting this.

    Another cause of sore nipples is, of course, thrush. Was this ever considered?

    Also it has been found that when a mom has nipple injury and nursing hurts, often a bacterial infection is found on the nipple when mom is cultured. In that case, oral antibiotic treatment is usually very effective. This is probably due to the injuries on the nipple being infected. I am not sure this would be relevant if you have no open injury.

    Personally, I have experienced deep bruising that hurt for a long time after early latch issues were solved. It just took a long time to heal. Not months, but at least 3-4 weeks.

    Overproduction (really, being engorged or having a very fast letdown, or both) a may cause a baby to have a poor latch. But in and of itself it has nothing to do with nursing hurting. Engorgement and fast letdown are things that can be improved upon even while mom has OP. IN fact, they are usually improved a great deal by 1) nursing frequently and 2) adopting a laid back or leaning back nursing position with baby on top, or a sidelying position.

    EASY schedule- There is absolutely no reason to be nursing your baby every 3 hours instead of cue feeding. If you do have OP and fast letdown, and since you do have latch issues, nursing on a schedule is probably not helping and may well make matters worse. I strongly suggest, let your baby's routine after you return to work take care of itself and encourage baby to nurse more often. Also there is no reason a baby needs to be fed on a schedule ever, even when fed with bottles.

    Here is why. IF you have OP and fast letdown and that is causing a poor latch, you want baby nursing more frequently, at least part of the day. Because the longer milk sits in the breasts, the more it builds up and the letdown is faster causing (possibly) poor latch, and the 'lots of foremilk at once" that might cause discomfort and green poops (It has nothing to do with not enough hindmilk, FYI.)

    Even if it is just a matter of a poor latch unrelated to fast letdown or OP, again, frequent nursing helps. A baby who nurses frequently is calmer and more likely to latch comfortably -"gently"- The nursing sessions may also be shorter. Both can be very helpful when there are latch issues.

    OK< about OP and block feeding:

    I am not convinced you have OP or, if you did, that you still do. Your baby's gain rate seems normal, not overly fast as would be the norm with OP. But it is hard to know for sure without having exact weight check for the last two weigh-ins. That would help to know how gain rate is currently.

    Does baby show other signs of fast letdown? Choking, sputtering, coughing, or gulping loudly at the breast? Are poops copious and explosive? Do you feel engorged between nursing sessions? Right now with the 3 hour schedule, you are letting each breast go for 6 hours apiece with no nursing. If you have OP, typically this would be causing some very noticeable breast fullness or engorgement. Is that happening?

    Overproduction responds very well in almost all cases to block nursing. But block nursing is not nursing one side at a time. That is just a normal pattern for many babies. Block feeding is nursing on one side for 2 or more sessions before switching. The idea is to "block" one breast (not remove milk) for some period of time and allow it to become quite full. That fullness tells the body to reduce production in that breast. It has been found that to avoid engorgement from becoming too great, it may help to hand express enough milk to relieve pressure during the time a breast is being "blocked."

    Blocks can be anywhere from just a couple hours up to 12 hours long. It depends on the severity of the OP and also on moms storage capacity (how long it takes the breast to actually feel full.) Baby should continue to nurse with normal frequency- a minimum of 8-12 times each 24 hours.

    Block nursing in this fashion is very effective in reducing production, and has been known to way overcorrect the problem and lead to low milk production. So it is important to be 100% sure that you really are making much more milk than baby needs before going long blocks of not nursing. When there are latch issues, some IBCLC will suggest block nursing is not appropriate, because it may be important that mom makes more than enough milk so baby is able to get enough milk even with a poor latch.

    I also suggest that if baby is gaining fine as I think you are saying, you can be fine with short nursing sessions. You are insisting your baby nurse for 20 minutes when your baby clearly does not want to. why? This is not necessary for your baby to get enough. If you have fast letdown, baby is getting all they need quickly. On top of that, your baby is almost 4 months old. Quick nursing sessions for at least some or even most nursing sessions are entirely normal at this point.

  3. #3

    Default Re: Fussy baby with latching issues - Please HELP

    Wow. This is a lot thanks. At her two month appointment, her weight was 9 1/2 lbs.

    In the beginning, I definitely believe that there definitely was oversupply. She was choking and coughing at most feedings, and when we did weight to see how much she ate, it was nearly twice what the expected amount at the age was. There was one day where I saw spraying her in the face without even touching my breast. But since that tapered off, there's only been an occasional coughing/choking episode, and I think the last one was shortly after her two month checkup. But poops are definitely copius. They're always first thing in the morning, usually her first two diapers, and they often leak out. And funny enough, as I'm typing this, I had to stop because she had her 4th for the day.

    I do the schedule because that worked for my son. His hunger signs, if any, were few and far between. Even now, as a toddler, he still doesn't eat a lot, even when it's his favorite foods. We call it eating to live not living to eat. So for kid #2 we went with the same thing for my daughter because it worked so well with my son. You go with what you know.

    Thrush has never been suggested. The pain I have is mainly only when I'm nursing. I have soreness most of the day, but I've always just assumed it was because my nipples were just sore. But it is like a burning, itchy sensation. And this morning I did notice what I thought was dried milk on one nipple. I did have cuts in the beginning. We used the silver cups, and they healed. It was shortly after I stopped using them that I started using the nipple shields. What's also interesting is that at the end of my pregnancy, my son had a yeast infection that would not go away. Stubborn thing. We were at the tail end of treating the second (and last) fight with it when I had my daughter. Could that have been the source? Could I have had thrush for the last 3 months? Wouldn't there be other symptoms?
    Last edited by @llli*kellyleia; July 21st, 2016 at 12:43 PM. Reason: Additional info

  4. #4
    Join Date
    Jun 2009

    Default Re: Fussy baby with latching issues - Please HELP

    Yes OP is actually quite common in the first month or two, especially with second breastfed baby. And you may still make a little more than baby needs even now. But I am not convinced it is of the severity where block feeding is appropriate. OP is actually not usually a problem unless it is pretty severe.

    Fast letdown and OP: What makes a baby cough or gasp, latch poorly, spit up lots, poop a ton, poop green, be gassy of fussy when a mom has OP? Actually it is not the OP but the fast letdown that so often comes with it. Because that (the Fast letdown) makes it so baby gets lots of foremilk (milk that is higher in lactose) all at once. Why is that a problem? Well, in many cases it is no problem at all. Lactose is good for babies-they need it to have the energy to grow. But SOME babies have a hard time handling either the quickness of the flow or digesting the extra lactose they get at a single feeding. Or they have a problem with both. That is why doing things to help baby handle the flow and get less milk at once (frequent, smaller feedings, leaning back position or sidelying position) help. Reducing milk production by block feeding or any other method is not always needed and only helps (if mom really has severe OP) in the long term. Also, if feedings tend to be widely spaced, fast letdown can continue to occur even if milk production is normal.

    I get it, scheduling can work great for some situations as long as baby nurses often enough overall. But it causes many issues in other situations, and one of the situations it causes issues is if baby is having trouble managing mom's milk flow. Because scheduling tends to make that worse because it causes there to be a longer time between nursing sessions than would otherwise be happening. It also causes issues when there is latch pain in general because of the reasons I explained above.

    Thrush: The most obvious and common indication that thrush is present is pain while baby is nursing. Yes some moms with thrush feel pain all the time, and sometimes there are other symptoms including symptoms in baby. But NOT ALWAYS. In fact, baby being asymptomatic is common.

    Thrush is very hard to diagnose and was for years WAY over-diagnosed as the primary cause for latch pain (when in fact, poor latch is the most common cause by far) and that may be why your helpers have not brought it up. But just because it is over-diagnosed or hard to spot or confirm does not mean it is never at least part of the problem. Given the history with your son and the intractable pain I think it is certainly a possibility. Here is a good article on thrush and what can be done about it: http://www.breastfeedinginc.ca/conte...agename=doc-CP

    Here is an article about helping baby handle fast milk flow: http://www.nancymohrbacher.com/artic...Fast+Milk+Flow It is about the early weeks because that is when this issue is typically occurring. But these tips work for anytime.

    Here is more, just, again, I suggest be careful about block feeding ("adjusting your supply") as discussed in second half of article. http://kellymom.com/bf/got-milk/supp.../fast-letdown/

    Here is an article that explains how to do block feeding and how it can cause issues with production if done inappropriately. : http://www.nancymohrbacher.com/artic...=Block+Feeding

  5. #5

    Default Re: Fussy baby with latching issues - Please HELP

    I went to my ob and she's convinced enough that it could be thrush to put me on nystatin as well as difflucan. And I'll be calling the pediatrician when they open today. I've been thinking for a while that it wasn't oversupply anymore, but the LC still believed it was. I kind of need this to be the cause because I feel like we've gone through almost everything else. Although that means that I probably won't be able to build up a freezer stash before I go back to work. And what I've got I'll probably have to throw out. . Oh well. If it means I can breastfeed without issue, I'll make it work.

    Thanks for your help!

  6. #6

    Default Re: Fussy baby with latching issues - Please HELP

    So I figured I'd give an update so I can maybe help any other moms out there.

    After this post, I took DD to the pediatrician to get treatment for thrush since my OB put me on nystatin and difflucan. The pediatrician said she saw no symptoms and really didn't think it was thrush. I almost started crying right there in the ped's office. I started going through the whole thing with her and ended with I needed to fix this. The ped asked if I had seen the lactation consultant they used to have, I'll call her M. M used to be out of one of their other offices, but had started her own service with an office not too far away. We'd seen her at the other office with my DS. When I started this whole ordeal, M wasn't approved by insurance yet. The ped said she loved M and she had worked wonders with her. Long story short, I made the appointment. At this point it's been almost 2 months since I'd seen LC#2. M didn't see any signs of oversupply at this time. And the fact that the baby was fine to start, but got fussy after a few minutes, showed her that she maybe wasn't getting enough milk. Sure enough, we weighed her before and after nursing and she wasn't. After some poking around, here's the hypothesis she had, and with the corrections she's given me, things do seem to be improving.
    1. DD has a lazy/inefficient latch. M said that she latches fine at first, but she kind of lets go after a while. She also said for the first few months, lactation is all hormone driven, so DD didn't really need to do much to get milk going. But now, as things have regulated and DD isn't doing what she's supposed to do, and with all the attempts at reducing supply, it may have caused some undersupply issues. She gave me some tongue exercises to do to help her get latching the correct way the whole time.
    2. Attempt to stop using the nipple shield. Which I'll admit, was not easy at first. But since this was probably also contributing to this laziness.
    3. Craniosacral therapy. And she gave me a name of a therapist, which is more than the other 2 LCs had given me. I did see a CST therapist, and I'll elaborate on that later.
    4. Possible Raynaud's/Vasospasm causing pain on my side. She wasn't convinced, but since my nipple was purple after nursing, it could be why I'm in pain. She recommended 100mg of B6 twice a day (with Dr. Newman's website as a reference). If after 1 week, nothing changes, just stop the B6. If it is in fact Raynaud's/Vasospasm, we can address that after the latch/weight issues are resolved.
    5. Pumping for 10 minutes after every other nursing session, and having my husband give her a bottle with the "proceeds" in the evening.

    So far, in the week it's been since I've seen her, I can more or less nurse without the nipple shield on both sides. I was able to do partial feedings before the CST and the B6, so I have to believe that its the tongue exercises plus the increase in my supply (every day I get a little bit more from those extra pumping sessions). I was actually nursing her without the shield in the waiting room of the CST office. Sadly, DD has now entered the super distractable phase, so that is throwing a wrench into things, but I think we can deal with it.

    So, CST therapy. Two days ago, I did see a CST therapist. I was really skeptical about trying this. Not because I was afraid that the therapist was going to hurt my DD, but that I'd pay money (since I'm in an HMO and she's out of network) and it completely not be worth it. I'm a very logical person. I'm in IT, so I like things to have clear cut causes and solutions. The only real tests of CST that have been done have been backed by the organization that provides training and certificate for CST. And that's like Coke funding a study to say that soda doesn't make you fat. But I digress. Either way, I figured since now 3 LCs had suggested it, I owed it to myself and my DD to try it out. The therapist is actually a Dr with her degree in physical therapy. At the appointment, she gently put her hands on DD, who was in my lap, upright, facing out. After about 6 or 7 minutes, DD started getting upset. We changed positions and allowed DD to nurse while the therapy continued. We finished the session, and then she had me put DD on her table so that she could take a look at her from a physical standpoint. I've always thought that DD was not relaxed. My DS would melt into me when he nursed, but that just never was the case with DD. The therapist agreed with me based on what she found from both the CST and physical observations that she looked/felt tight and that things definitely needed work. She gave me a couple of body stretches to reduce the tightness in DD's neck, as well as additional tongue exercises, as well as a product recommendation to prevent DD's neck from leaning to one side. This is where I think her value lies. I believe in physical therapy work (my husband is actually doing it right now for knee issues). I will continue to perform the stretches until my daughter seems to relax. DD actually enjoys them so it's really not a bother at all. At $150 a session, I just couldn't justify going back 2 or 3 times for something I just don't see the benefit in. Especially when I started seeing improvements before I saw her. If it was just a $20 copay, I would absolutely continue.

    I think part of the lesson is to remember that if you don't like what one doctor or other medical professional is saying, go find another, and another if you have to. I started looking for another LC when I wasn't happy with LC#2, but the person I called ended up referring me to LC#2. I assumed that she was "the best" if two people referred her. I'm sure she's a very capable LC, but I think that she got stuck on the oversupply issue that LC#1 had originally seen. I'm not going to blast her on the internet, but I wouldn't recommend her to anyone at all. If anyone is looking for an excellent LC in central New Jersey, please PM me and I'll give you the contact information for M. I feel like M really started from the beginning and assumed nothing until she had seen things for herself. She's also followed up with me better than the other two LCs. Lactation consults aren't often a "one and done" type setup, so while I did reach out to the other two LCs when things still weren't right, M was the first one to follow up with me without being prompted.

    Hopefully my issues can, if nothing else, enable some other mom to continue to search out solutions until things improve, even if that means finding another doctor/medical professional.

    Thanks maddieb for making me doubt that oversupply was even an issue anymore. I'd had my own doubts, and even asked LC#2, but she said she still thought it was over supply.

  7. #7
    Join Date
    Jun 2009

    Default Re: Fussy baby with latching issues - Please HELP

    Thank you so much for the very informative update. I am glad you have finally found a helper you feel confident in. It really makes all the difference.

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