Breastfeeding case study of Isabella Rose – 18 weeks, from Danielle

Birth: for the first 9 days Isabella fed well, gained weight well and we were discharged from the midwives. On day 10 I had noticed she started to become unsettled & crying increased a lot and she started to cry a lot in the pram and feeding times increased and I felt like I was feeding around the clock, mostly every 30 minutes. Prior to this she was very calm, slept & fed extremely well and only cried for nappy change or food. But as her weight was good and midwives were happy with how she was feeding they said there was nothing to worry about and to keep feeding on demand.

2 weeks post birth: I started to notice Isabella was slightly wheezy in her sleep when we laid her flat in the crib to sleep and had started to cough frequently throughout the day. From 2 weeks old we could not get her to sleep in the crib at all she seemed very uncomfortable and squirming around continuously (prior to this she had been in there for the first 2-3 hours of sleep every night). We spoke to the health visitor who advised using a wedge under the crib, this did nothing and we moved to permanent co-sleeping holding her in my arms for most of the night.
Isabella remained unsettled in the day times, her gas got much worse, and she was bringing her legs up a lot and seemed to be uncomfortable frequently. Alongside the coughing she was also sneezing & hiccupping frequently. She was not enjoying the pram, car seat or lying flat, with us holding her most of the time. We tried to persist with baby wearing but every time we tried, she became even more unsettled banging her head against our chest or turning her head side to side. She also hated to be swaddled which we guessed was the reason for hating the carrier.

History after birth to present day: Feeding around the clock, mostly every 30/ 45 minutes up until month 3. We then started to see some stretches reach 1 hour/ 90 mins and the rare 2 hour stretch but feeding patterns day to day were all over the place. Isabella seemed to become more and more unsettled as the weeks went by with daily episodes of hysterical crying and becoming very difficult to settle. From around 8 weeks she started spitting up frequently and seemed distressed/ frustrated for a lot of her feeds. She also seemed like she was hungry all the time, with hunger cues nonstop but then being difficult to feed/ or only feeding for very short periods of time.

At 11 weeks, Isabella unfortunately had a choking episode where she stopped breathing for 3-5 seconds and was then struggling for breath for around a further 20 minutes. Prior to the choking she had woken up hysterically crying with sick coming out of her nose, which is then when she started to choke. An ambulance arrived and advised we go into hospital to speak to a consultant just to be safe. The consultant did no checks, just advised that Isabella had reflux and was feeding far too frequently and that I should use a dummy as she was using me to soothe and only feed her every 2 hours minimum and prescribed omeprazole. I was not happy with this advice; in my gut it didn’t feel right which is when we started to dig deeper into how we could help Isabella’s reflux without medication.

The first step we took was adding in a probiotic and having Isabella checked for a tongue tie. The check we had unfortunately was very basic, the oral surgeon advised she could poke her tongue out fine and there was no tie. After I kept reading about tongue tie & tongue tension I still felt Isabella was showing many signs of either tension or a tie with her feeding behaviour and latch so I recently this week spoke with Carmelle Gentle who helped to take a look at Isabella’s latch and feeding. Her observations were that her upper lip is tucking under too much, her chin is not coming down wide enough to get really deep and as a result is leaving gaps at the side where air is getting in and milk is leaking out. She also observed how Isabella splutters, pushes the boob away, bobs her head on and off, pulls the nipple back, slips off and sometimes clicks and will then try to re-latch but normally end with frustration and resulting in Isabella being very unsettled. She also regularly is very wriggly during feeds, turning her head & arching her back. With hiccups occurring normally once or twice a day, sick after feeds, coughing and sneezing. Post our consultation with Carmelle we have come away with some exercises to carry out for one week before speaking with Carmelle at the end of next week again to assess and review how things have progressed to see whether a second tie examination is needed.

I have also been on an elimination diet for 2 weeks, we did see a great initial improvement 3 days in but this past week we seem to be all over the place again, so hard to tell if this is really making a huge difference and unsure where to go from here with this. Currently feeding is still all over the place, normally every 45 mins/1 hour/ 90 mins max. Day time feeds are the most challenging, feel like we are in a constant cycle of short, uncomfortable and grizzly feeding pattern. Then alternatively we then have excessively long feeds where Isabella seems much more relaxed and comfortable, these feeds only happen normally at night when Isabella is sleepy resulting in her either sleeping on my boob slowly nibbling for an hour or falling asleep during these feeds. Her latch is also much better with normally no sick coming back up/ being unsettled afterwards.