Help her fight her rising panic that if the baby doesn't latch soon, it's all over.  This baby is only two weeks old, the mother is protecting her good milk supply for her gaining baby, and if the baby can latch sometimes, she will learn to do it more consistently.   Reach back across your experience with stories of babies who needed some time to "get it."  (This hand-out by Diane Weissinger is helpful for making her feel some common ground  http://www.normalfed.com/help/babyget/  

Explore why she doesn't want to use the shield.  Agree with her that it is a fiddly piece of equipment (particularly if someone has big soft breasts) but maybe no one showed her how to anchor it, or they gave her a small one that hurts (I tend to use as big a shield as the baby can manage -- the 24 mm or the Mamivac 28mm).  Agree that the goal is to get the shield out of the picture again, but it could be a useful temporary tool -- right now the baby is frustrated and screaming at the breast.  If the working method right now is pumped milk in a bottle, the shield a big step in the right direction to get the baby happy and feeding at the breast -- cozying up against the mother and trusting the position again.  Babies who are learning about the breast and bottle together are not patient with the breast -- point out how serious newborns are about survival.  The shield provides a firmer oral signal for the disorganized little tongue-- a little bridge from the bottle back to the breast -- letting the baby learn that milk goes on top of the tongue.  As long as the baby is transferring milk reasonably well, and the mother is doing a little "insurance" pumping, there's no emergency to get the shield out of the picture.  But she should keep offering without the shield, maybe mid-feeding, to keep the baby familiar with the real breast, to ease the transition off the shield.

Continue lots of skin to skin.  When a baby is sorting out all these different oral experiences, encourage the mother to start the feeding with the baby upright (maybe with a little headstart with the bottle to calm the sensitive baby), leaning back a bit so the baby is secure and planted, and wait for the baby to organize and begin the search -- the rooting sometimes helps get the tongue in the right position.   To compete with the bottle/shield, the mother may need to exaggerate a big Rebecca Glover-style  "sandwich" of breast tissue to trigger the suck.

If a baby is continuing to have difficulties, consider further investigation to see if there might be some neurological component, or whether some kind of physical therapy/bodywork would be helpful.  Is the baby just frustrated and upset with the feeding attempts, or do you have a sense of tight muscle tone or asymmetries  overall?

Margaret Wills, IBCLC Maryland USA

> 
> Date:    Tue, 14 Mar 2017 10:30:52 -0400
> From:    Lou Lamb <[log in to unmask]>
> Subject: Extreme tongue elevation, help!
> 
> PTP:  I'm desperate for advice for a 2 week old, full term baby, who has the worst anterior tongue elevation (curled up to the roof of the mouth) that I’ve ever seen in my 20 years.  Mom was started on a nipple shield in the hospital which worked nicely to force the tongue down, but she stopped using it a few days ago and, I quote, "never wants to see it again.”  Babe will not consistently latch & so mom is trying to BF, but giving lots of bottles (Dr Brown’s) of EBM.  Mom has an abundant supply, no issues with overactive MER, and baby’s weight gain is good. 
>    On my visit, I tried modified football (upright) to try & drop the tongue, suck training exercises before latching & swaddling, as this baby is hypertonic, and the charm hold.  We had a couple of good, but brief latch ons & only after major struggles & nothing consistent.  As soon as she gets to the breast, she starts to scream & her tongue immediately lifts up & blocks any latch.  Thoughts?
> 
>     

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