Hello Marna,
I worked with a very similar case.  Labor and delivery uneventful, even the
epidural was administered about 20 minutes before birth, breastfed in
delivery room, no bottles, no red flags at all.  I saw the baby when she was
3 months old.  She was growing beautifully but would fuss a lot on the
breast.  She didn't fall asleep milk drunk at the breast like mom's previous
kids. She did a bit better side lying and much better in her sleep. She also
wouldn't keep a pacifier in her mouth no matter how hard mom tried - she
already raised 4 on pacifiers and wouldn't think of not using one.  Baby
couldn't take a bottle either.  After all the usual latch fixing etc... I
did an oral exam and found that baby just didn't suck.  She moved her tongue
around, licked whatever, but no sucking.  Her tongue movements do not seem
limited at all, just no suck, not on a finger, a breast, a bottle or a
pacifier.  I accompanied the mother to the SLP who was stumped.  She said
that baby seemed fine in every other way and would not have eating or speech
problems later on.  That's nice but what about now, where was the suck?!
Thinking in terms of basic instincts, I advised the mother to start
co-bathing, skin to skin etc...  Mom discovered that she loves co-bathing
with her baby and lo and behold, baby started nursing!  In fact I just ran
into Mom and Baby this morning, and Mom proudly showed me how well the baby
takes her pacifier.  OK, I don't love pacifiers, but I was thrilled that
this baby could give me a good game of tug of war with it when before she
couldn't or didn't even hold it in her mouth.  I don't know if this will
work for your mother and her baby but it is certainly worth a try.
Fortunately for the dyad that I worked with, the mother's milk just kept on
flowing despite everything so neither weight gain or milk supply was an
issue.  Not everyone is so lucky.
Good luck to you,
Chayn in Israel, IBCLC

----- Original Message ----- 
From: "Marna Moore-Barr" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, July 14, 2007 8:45 AM
Subject: Chewing Only--


> Hello--I have a case making me scratch my head-- thought everyone else
will
> have an idea-- PWP-  New case to me of a now 4 week old BG, born on due
> date, gestation age assessment also states 40 weeks, BW 7 lbs 4oz.  Per
> parent history baby has never able to latch at breast, kept longer in
> hospital due to this (3 days) for these feeding difficulties, then DC with
a
> bottle.  Baby born with an epidural, but other wise non-eventful labor and
> delivery. Oral assessment with a +gag, unable to engage any
> coordinated/purposeful tongue action, mostly tongue lays at bottom of
mouth,
> touching lips gets positive tracking and opening.  Tongue is not tied, has
a
> groove, is not short or long--it looks normal but simply does not move,
but
> with random movements (honestly in 12 years have never seen anything like
> it)!! Palate also normal, airways open.   Parents have been feeding EBM
> using a bottle with very fast rate-- on initial contact attempted cup
> feeding with a lot of crying and  stress seen on baby. Parents also hated
> the cup-- attempted fingerfeeding with no results, baby will not engage to
> suck!!  When I place 5 cc in mouth via finger tube, baby able to swallow
it
> without problem. Baby observed with paced bottle feeding with both the
fast
> and slow flow bottle.  Baby uses jaws only to chew bottle then able to do
a
> swallow and breath-- did this all with a very slow flow bottle much easier
> then with the fast flow.   I referred baby back to ped for oral eval,
> encouraged no pacifer (which baby was offered by parents, but never took)
> and adult finger offered for sucking at least 4 times per day, as
tolerated
> by baby.  Ped states if baby can bottle feed then there is no issue!!  No
> further eval needed.  We have no CST in area and even speech/oral
therapist
> rare and the two we have do not want to eval a baby---I saw the baby today
> after  one week of finger sucking at home and paced slow flow bottle use
> with no change to oral assessment-- What else can/should I be doing?
>
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