Chayn,
I have seen the same type of issues with babies that are latching very
shallow due to increased sensitivity/forward gag.  Saw a mother baby
pair not too long ago.  The few frenotomy patients that I see almost
always do better immediately but I did have one similar to your
situation.  The most recent forward gag/shallow latch appt, I worked
with our occupational therapist as well.  The treatment recommendations
were not a magic fix.  Mom needs to relatch and relatch, going back to
the basics to widen the latch.  Changing a poor habit takes time, and
unfortunately, it is usually mom that has to do the work.  I think they
get very frustrated when the recommendations are not comfortable for
them, meaning they have to contine to put time into relatching over and
over to break the shallow habit.  Does the baby have cupping of the
tongue or is it bunched or humped?  What I am asking is: doe the tongue
have a midline- front to back groove or does it stick up like a
mountain?  When it pushes up like that, it is usually trying to push the
breast out of the mouth as they are trying to settle in shallow again.
You are right when you say that they baby probably needs desensitized
for a more posterior gag reflex. Again, it takes time, and there is no
magic.  So, finger exercises with gentle and down ward pressure, pulling
the tongue out slightly over the gums can help to promote the cupping.
You can use a finger also to gently, gingerly enter the mouth, rubbing
the gums outside and inside, the hard palate several times a day.  Go as
far as you can without gagging the baby.  Sometimes, a pacifier can be
of help with this issue, if the baby is well established at the breast.
Even if it is just for "exercise" time.

Angie Kirkwood RN, BSN, IBCLC

Nurse Feeding Specialist and Certified Lactation Consultant
Children's Hospital of Pittsburgh





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