Hello, Lactnetters -

This situation came up today and I've not dealt with or remember reading
about it anywhere before. So, I'm asking for your thoughts/suggestions.

Mom of 2 week old infant, who has been feeding/gaining well up until late
last week, called me this morning. I had done a home visit about 2 - 3 days
PP. Baby was jaundiced and VERY sleepy. At that time, we discussed the
rubber nipple issue. Mom was receptive and seems dedicated to BF, (but ya
never know?). Anyway, now she states that beginning last Friday she's having
difficulty getting baby to latch-on properly. Says she sucks in lower lip,
can hear air wooshing in during feed, nipples are becoming more sore by the
day and feels like baby not getting enough. Also, experiencing some engorgement.

After some investigating, she admitted she used a pacifier one day while
taking baby to doctor in car and in office. Pediatrician recommended water
feeds to continue to bring down the biliruben. Mom tried the water a couple
times, baby sucked a couple times then spit out the nipple, became upset, so
mom decided it wasn't worth fighting over with her. (Incidentally, when she
reported this to the Dr., he said don't worry about giving her the water.
Maybe the baby will teach this Dr. something!) Then when this "lip
sucking/I'm afraid she's not getting enough" thing started she broke down
and gave a 2 oz. bottle soy ABM twice.

She said that the baby sucks on its lower lip when she's not at breast, in
her sleep, etc....came out of the womb sucking its lower lip. We concluded
that this is a behavior that needs working on, she may be VERY prone to
nipple confusion and that NO rubber nipples should be used.  Mom has already
seen what ABM can do to her normal breastmilk stools.  We talked about
feeding in the football hold position to assist with proper latch, trying
different positions with each feed or during feed, growth spurts and how to
guage baby is getting enough.

As for the "lip-sucking", mom states that she tries to pull the lip out
after latch-on if she is sucking it in, but it's real hard to do.  Baby
usually gets upset and comes off.  I suggested she keep trying to get a
correct latch, no matter how many times it takes to get it right and once
she gets it right, to leave her there till comes off on her own.  Mom was
taking her off if the sucking slowed down and baby was just hanging out. Now
this one I just pulled out of the air...I told her right before latch-on to
run her finger between baby's lower lip and gum a few times, making sure to
roll the lip outward. Then to check it again after latch and during feeding.
I don't know if this will work and I told mom so, making sure she lets me
know how it goes.

Has anyone had any experience with this before and/or have any suggestions?
I'd really appreciate any help anyone can give. You can e-mail me privately,
if you wish.

TIA

Melody Engberg, IBCLC, LLLLeader
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Methodist Alliance Health Services
Memphis, TN
Brad Engberg
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