The breast is generally soft the first day or two after birth, and then 
becomes firmer, creating more of a challenge to babies who have 
restricted tongue mobility. The salient stimulus for latch is the tongue 
tip contacting the breast. If the breast is 'in' the baby's mouth but 
the tongue tip is not touching the areola, it will feel like nothing is 
there to the baby and he'll continue to root (moving his head side to 
side to try to contact the breast) and will cry if this doesn't work. 
After a few days of frustration and little milk (another consequence of 
one's tongue not having proper range of motion) babies can shut down and 
refuse to be frustrated further.

If you are not sure there is a frenulum, absolutely get some body work 
for this baby, then reassess tongue mobility. Your tube under nipple 
shield strategy was a good one, but it needs to be done in a way that 
does not frustrate mom and baby. Take a step back and start having baby 
'latch' onto the bottle, start mom bottle feeding with baby's cheek 
touching her bare breast, and controlling the flow from the bottle. Then 
offer baby breast for dessert when he is calmer. Presenting a larger 
mouthful of breast to the baby's tongue tip while the nipple brushes the 
philtrum (that cute little dent between nose and upper lip) pushes the 
'right' buttons for baby to open wide and grasp the breast.

We've all sometimes stressed moms and babes to try to make it work at 
the consultation, I know I have. I hope you'll be able to have a follow 
up where you can all be less stressed. Calm yourself, scaffold mom (help 
her stay calm) and she'll be able to help her baby better.

Catherine Watson Genna BS, IBCLC  NYC  www.cwgenna.com

On 6/1/2015 6:41 AM, Riva Weissfish wrote:
> I tried checking the archives (I admit being a bit inept at that) but didn't find the answer I was looking for. Hope someone can help. PTP.
>
> I am working with a Mom and her 7 day old baby. Wonderful, uncomplicated, unmedicated , first birth. Mom breastfed in delivery room. Separate for a number of hours but then breastfeeds continued until night 2 and night 3 baby received one bottle of formula each. Weight loss of 9% at discharge. "All was fine"  until night 5 – baby started fussing and refusing breast. Day 6 baby fussy all day and crying when trying to latch. Baby would eat a small amount (by time) and fall asleep, then cry and try again. By night 6 baby was screeching and screaming when put to breast, even as nipple was in his mouth. Fell asleep without eating , woke short time later and repeated the process.  Finally gave bottle which he gulped down and fell asleep. Day 7 was a bit better , less screeching but still refusing. I came late day 7 in the evening, found peacefully sleeping baby. Mom picked him up and as he reached the breast he started screeching (the only word I can use –it wasn't just crying!) Tongue does not pass the gum line consistently but I don't feel any bump or unusual frenulum under the tongue and it is all quite soft and flexible with a low wide palate. No asymmetry, tone seems normal. We discussed recent changes of diet,  soap, deodorant, creams, etc – all negative. No oversupply, was temporarily mildly engorged on day 3-4 and supply normalized quickly. Leaks when baby ready to breastfeed. Nipples are sore but not excruciatingly painful
>
> I tried the following positions and interventions: football , laid back – self attach, cross cradle ,standing - with and without bouncing,  no hands, swaddled, naked, bait and switch,  in various combinations. He did calm down when swaddled and "shushed" , but would not take the breast. Finally tried nipple shield and flow with tubing and syringe and he ate and fell asleep.  Mom could not reproduce these results at the next feed and they are pumping and bottle feeding. Mom is totally exhausted and I am afraid I was a bit over zealous and continued to try to latch baby even after she could not cope.  I did ask her if she wanted to stop the session , and she insisted that she wanted to succeed to nurse him but by the time I left she was totally drained.  Should I have just had her finger feed or bottle feed?  If it was reflux/sensitivity  related wouldn't the bottle also be problematic? Would body work be appropriate even though there are seemingly no signs (long or complicated birth, trauma or asymmetries) that indicate that this might be needed.  Would it be appropriate to release the tongue even though it is not  "typical" (it indeed does not lift or pass gum line –perhaps it is a tightness that cst would release and not actually ankyloglossia proper)
> What am I missing?  You might have picked up that I am not quite sure what I am looking at here and how to porceed.  Any insights??
> Thanking you in Advance,
> Riva
>
>
> Riva Weissfish BA, CCE IBCLC
> Childbirth Education, Lactation Consulting, Parenting Workshops
> [log in to unmask], Cell:972527176093   Fax :97226512139
>
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