Hello everyone!

New puzzling case for me here.  I have never seem a baby do this at the
breast before.  Not this severe anyways.  Here is the story:

First baby for this mom.  Normal pregnancy without any complications.  Full
term.  Induction for lack of progress.  Ended up with a c/s during the
middle of the night (something like 12 hours after induction started)
because baby was not tolerating labor.  Epidural with Morphine was used
during labor.

Baby was born without any complications.  Adjusted well to extra uterine
life.  I am not sure if baby was allowed skin-to-skin and breastfeeding in
the first hour.

In the first 24 hours, baby never took breast.  Too sleepy, not interested.
 Tried several times without success.  Baby was not put skin-to-skin and
baby was in the nursery because of protocol (all c/s babies are in the
nursery for first 24 hours unless dad or visitors are with mom).  Baby
started turning jaundiced and was put under photo therapy at a little over
24 hours old.  Baby started to receive formula via ff after attempts at the
breast and breastfeeding was attempted every 3 hours.  No pacifiers or
bottles were given to baby.

Baby started getting hungry and started to root for breast.  From what I was
told, baby couldn't latch on to the breast and would push away and scream at
breast.  They said she would pinch lips closed and refuse to suck.  A nipple
shield was tried without much success as baby would just suck on the end of
it.  Suction was said to be more chewing than sucking.

When I saw this mom, she was over 48 hours pp.  Baby was well awake and
rooting.  She opened wide and did latch to the breast well but was making
these awful smacking loud noises sounding almost as if  she was smacking her
tongue from the roof of her mouth to the bottom of it.  She was putting no
suction on the nipple and was on a few occasions hurting mom by bitting down
or clapping down on the nipple.  Every once in a while, she would get in a
few sucks  but would go on to the same clicking noises.  The sucks were not
very strong or adequate to remove milk.  I did an oral exam and found no
abnormality except a short frenulum that seemed to be tied rater in the back
of the tongue.  When attempting finger sucking, baby could not extend tongue
further than the lower lip.  She would cup finger with tongue but you had to
try several time before she did it right and even then, it wasn't a full
cupping like other babies usually do.  Suction was good.  Baby stayed calm
while attempting to breastfeed and did not push away from breast.

What I recommended this mom do is try baby at the bare breast for at least a
couple of minutes but not overly because nipples were starting to get sore
and baby was chewing them out.  I said if baby wasn't getting it after a few
minutes to finger feed baby while holding baby close to breast.  Do lots of
skin-to-skin with baby and to pump after every attempt at the breast.  Tube
at the breast didn't work either so that is why I suggested ff.  I also
showed mom how to stimulate suck and how to try to do suck training with
baby to help with tongue extension and cupping.  I asked the nursery nurse
to have peds look at the frenulum but I guess she never did.  I guess mom
ended up giving up and offering bottle.

Did I miss anything?  What else could I have done?  Our peds aren't too
willing to clip frenulums....

Thanks for your imput!!!

Celine Cormier, RN, BN, IBCLC

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