Hi All,
I have this mom coming in later this week for a follow-up appt with me. She came to me last week for a "poor feeder at breast". The baby is 1 month old, weighed 6#10oz at birth, lost down to 5#10oz, and at one month was 7# 9oz. Great weight gain, but mom has been feeding him 4oz ebm from avent bo. every 3 hours. She reports he falls asleep at breast after just a couple minutes of sucking, so she gives him the bottle of ebm. It takes him over an hour to feed. ( I know your already wondering why she gives him so much, I'll address that in a minute)
So, in my office his oral assessment appears WNL. Moms nipples evert well and remain in good condition. Baby is put to breast, chomps only, falls asleep. (obviously falls asleep because he isnt getting anything d/t his chomping) I did some gum massage and finger sucking to see if improved any. Baby grooves his tongue around my finger, but doesnt pull it in at all. My finger is easily removed from his mouth. Frenulum is WNL. Put back to breast with shield and SNS (with glucose water as mom didnt bring any ebm......also going to flow faster than formula). Baby continues to chomp at breast while I am stroking his jaw, pushing in his cheeks, stoking his throat........ He gets the feeding down in 30 minutes, mom never has let down. Pumped mom for 4oz, and observed his technique with bottle. No sucking at all. So I change from avent to haberman bottle, and within a few minutes, he SUCKS! 1:1 suck/swallow ratio. I try to keep things to what mom already has at home as much
as possible, so try "slow flow" avent nipple, instead of newborn. He continues to do well with this. Explained to mom how he has been burning a lot of calories by "chomping" for an hour for each feeding. That had she not been offering him that many oz. he probably wouldnt have gained as well. Sent her home with suck training exercises with her finger, soothie pacifier (to also aid in sucking), and continued attempts at breast. If falls asleep to bo. feed with slow flow nipple and mom to listen for 1:1 ratio.
I have been off, so don't know results of follow up phone call.
If no improvement, I'm thinking sending baby to suck therapist, or cranio-sacral therapy. What are ya'lls thoughts?
Linda
Linda
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