Dear Rose,

First off, try a deep asymetrical latch with the chin smooshed in and 
the nose away from the breast. If this is what you are doing, or doesn't 
help, then I would send this mother to a Speech Language Pathologist or 
Occupational Therapist for an assessment of the oral motor ability. 
Meaning what is the tongue doing, the cheeks, the palate, etc. With an 
SLP or OT experienced with babies, they can often find weak muscles in 
the facial/mouth structure and with correction baby nurses normally.

The big thing that jumps out at me is the tongue tie and the sore 
nipples. I would guess that the sore nipples stem from the original 
tongue tie and most likely baby is still not using his tongue correctly 
even after having it fixed. If his tongue isn't working correctly, he 
will also not be able to remove milk properly. Test weights done pre and 
post nursing would tell you how much baby is removing from mom. This 
would be the answer to your weight gain question.

It sounds like baby would benefit from extra calories -- supplementation 
at the breast if possible. (I am sorry, I am in a hurry and can't 
convert the grams to ounces to assess this better). If baby isn't 
gaining at least 6 ounces per week (6 x 28 would give the gram amount) 
then supplement is needed.

One can not go by how this baby looks or sounds at the breast -- I have 
seen too many babies look perfect with "active sucking" but the intake 
is terrible and shows us why the baby isn't gaining weight. If baby is 
having lots of BMs but not gaining weight, something is wrong!

Mom needs to be pumping with a hospital or rental quality breast pump 
after each nursing or with bottle feeds. She may need to pump 8 or more 
times each 24 hours to stimulate her milk supply while her nipples heal. 
I have worked with many tongue tied babies who can not manage a wide 
based baby bottle nipple and that gives us more clues. Watch how this 
baby bottle feeds on both a wide and narrow based bottle.

Best, Kathy Eng, BSW, IBCLC

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