Dear Pam, I would suggest an SLP or OT/PT experienced with babies, preferably nursing babies. I have had several babies diagnosed with various mouth area muscle weaknesses that caused their breastfeeding problems. I would also want a good test weigh during my visit to see how much milk baby is removing. The poor seal might have always been there, and baby "thrived" due to mom's good milk supply. Or, baby might be getting weak from poor caloric intake. I would also want to know if he could bottle feed, using both a narrow based nipple and a wide based nipple to see what he does on each. I find that when the baby can't even bottle feed then it is taken more seriously by HCP and the insurance companies. 

My friend's baby thrived and was fat until 4 months old. He got sick and stopped nursing well. Test weighs showed less than one oz. intake when nursing at that point. Now that he is 2 years old, Dad noticed that he doesn't use his lips when speaking. I wonder now if his nursing problem was really a lip or cheek weakness problem? Some babies can live off mom's abundant milk supply until about 3-4 months when it drops down due to lack of proper stimulation.

Good luck with this baby. Kathy Eng, BSW, IBCLC

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