I haven't come across this before, maybe someone out there has....

I have a patient that is 2 days old. She is an AGA (appropriate for
gestational age) white female, first baby - born by c-sec [I forget why].
Baby has a very prominent maxilla - upper gums. Her mandible [jaw] appears
to be normal size. There is no breathing obstruction or pierre robin
sequence. The upper gums appear normal shaped and symetrical, no evidence of
any tumors. Palate is intact. Tongue normal size.

To give you an idea - she looks like she's wearing one of those plastic
mouth guards the football players use. Her upper lip does not cover her
upper gums. When she's asleep there's still a little bit of the gums visible
between her lips. Mom thinks there may be some "overbite" history on Dad's
side of the family. Baby otherwise unremarkable.

Mom wishes to breastfeed [but only about 6 weeks] and bottle feed. According
to mom, baby has good strong suck, but falls asleep at breast. Nurses report
that baby is very slow bottle feeder - 90 minutes for 3/4 oz. Nurses feel
that bottlefeeding problem is related to overbite. I think that baby is
transferring colostrum because she is voiding and stooling quite well and
has only had 45cc's of formula.

Ideally, mom would just breastfeed, but that is not in the cards. I'm
considering trying a Haberman feeder, thinking that the baby can make
suction at the breast because it's pliable and conforms to the shape of the
mouth, where the bottle nipple doesn't and the baby has trouble maintaining
suction.

Has anyone seen this before?
Gail S. Hertz, MD, IBCLC
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