I visited a mom and her 2 week old baby today at home for milk supply
issues.  I had visited this dyad in the hospital at 14 hours post birth for
latching issues and noted a very hypertonic arching little guy, who rooted
madly, but couldn't settle down to nurse. Even arching profoundly in STS.
(She had an epidural..) The baby was fighting everything so I instructed
mom to hand express or pump if he continued to fight the breast. Due to his
rooting and oral aversion I did not check orally in babe.
  The next day I did a follow up, and talked briefly as mom said he
was "doing well" and "things had really turned around" etc. I felt
uncomfortable as I could see he was still arching, but felt dismissed. The
FP had followed up and had the Peds internal medicine doc check baby out,
and he felt they were fine, so home they went.
  She rented a pump from me 3 days later. I asked her how her baby was and
she said he was still really tense and arching. Yet, she was still not
interested in working on the problem of his not latching. I have very very
little experience with this issue (mom not wanting help).
   I told her about an infant massage therapist. At the 2 wk check today he
was 1 oz below birth weight and because of his continued arching is
scheduled for scans tomorrow.
   Okay here's the problem: Mom is pumping 6-8 times in 24 hrs and doesn't
pump from 8pm-8am. Hence, there's the supply issue. She is supplementing
50/50, and I discovered his frenulum to be a bit tight to boot! He is still
frantic at breast and cannot extend his tongue. So I got her set up for
clipping prior to scans. You are hoping I'll ask my question. OK. When
dealing with multiple issues, it's hard to know where to start. Even if the
clipping "works" I'm guessing he'll still be a very difficult little guy to
work with. Does anyone have ideas? What has worked for you? She has been
instructed numerous times by staff about increasing frequency of feeds and/
or pumping, but doesn't follow.
Sorry so long, Chris Clark IBCLC,RCP,CD

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