Jennifer, I have had 3 cases in the past 5 years similiar to what you
describe in your post. One baby could only stay latched for brief moments.
The tongue was mostly positioned to the roof of her mouth and when down was
short of the gum ridge.  The baby had a high palate.  This baby was given
bottles and had serious difficulties with bottlefeeding, too.  Mom had
c-section with this baby and baby was SGA (4 # ). The only thing that worked
relatively well was finger feeding with an SNS.  The mother/baby went to an
oral-motor clinic and got better at bottlefeeding breastmilk not
breastfeeding.  The other baby had similiar problems and likewise
fingerfeeding with an SNS worked the best. Baby never went to oral-motor
clinic due to transportation difficulties. This baby also became a
bottlefeeding baby but this baby became a formula-fed infant (mother had 3
other children and found pumping overwhelming).  The third baby  had similiar
problems.  This baby went on to total breastfeeding by 3 months of age. The
mother of the third baby refused to use an SNS and had extra help at home.
This mom also had a c-section and baby was considered preterm at 37 weeks but
weighed 7 pounds (mom diabetic).  Baby was jaundiced at birth and underwent
phototherapy in the hospital and at home. Baby had high palate. This mom
pumped, gave bottles--which took forever because of the difficulties, but
mostly nursed the baby for brief moments around the clock--2 to 3 minutes at
a time.  Baby did not go for oral-motor training although I did give her some
simple instructions on how to keep babies tongue down.  Baby was placed in
sitting up position.  The key element for this mom was the live-in help
(someone to take care of her other child and cook/clean for the family).  At
about 3 months of age something clicked and baby no longer needed or wanted
bottles (so mom quit pumping).  Baby never nursed at the breast for long
moments but mom was willing to keep baby with her at all times and nurse
often.  Mom had an excellent milk supply, too. Baby breastfed for 2 years.

All three cases were difficult and I feel that an infant that can neither
breastfeed or bottlefeed is a red flag.  Referrals to other people in the
health care system are important.  Some referrals do not necessarily help
breastfeeding.  I don't think there are easy answers.  And those answers
depend on what the mother can deal with in her family life.  The answers also
depend on the area one lives in whether a mother can easily access, get a
referral or afford specialists (be they traditional or non-traditional
specialists).

Is an SNS useful in these cases?  I don't know, since I have seen so few
cases like this. I do think that success maybe dependent on how much or how
little help is available in the homelife of the mom.  I do think that is a
crucial element.  I am not sure others would consider the intensive kind of
nursing done by this mom a success.  Yet, I have read about anthropologists
who have observed in traditional societies that infants nursed for 2 or 3
minutes every 15 minutes.  So maybe effective nursing is a wider range of
behavior than we think. Valerie W. McClain, IBCLC

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