Saw a two month old at the pedi office where I work.  Beautiful healthy
looking two month old.  Smiles makes eye contact lots of great fat reserves,
no problem with the weight gain at all.  Exclusively breastfed.  Very odd
nurser.  Lots of gas and green frothy stools more often than not.  Mom, an
anesthesiologist, who breastfed her daughter for a year looking for some help.

So I look at him at the breast.  He gets in close and gums the areola,
starts swallowing right away, but does not look unhappy or overwhelmed the
breast, and waits for the let down, licks up each drop, over and over and
over.  Mom says that occasionally he will latch and actually nurse, but it
is rare.  He just hangs out there all day, licking up the drops, literally.
 He nurses all night long while she sleeps.  In the morning the bed is
soaked with milk.  Run off no doubt from all those licked up letdowns.  She
sits him up to burp which he does easliy and brings up some fresh milk as
well.  I had mom do a breast cmopression to see what he would do, he just
smiled and liked faster, again did not seem overwhemlemd in the slightest,
but not really latching a making a seal either.

I do an oral assesmment, he smiles and coos at me, but does not suck. 
Facial tone and overall muscle tone seem really good.  He has a bit of a
heavy gag reflex initially but within a few seconds lets me put my finger
back to the hard and soft palate.  He lifts his tongue to the top of the
mouth when it is wide open.  When I press on his lower gums, his tongue just
stays back, it does not come forward (is he too old for this to work?).  The
front bottom gum is a little funky looking, off color, kind of greenish?,
and bumpy.  Mom reports that in the beginning he nursed really well.  Great
latch, according to the hospital "LC."  Agressively suctioned at birth for
meconium staining, but went right to breast.   Mom cannot recall when he
stopped really latching and nursing, or what it was associated with.  Does
not suck at a pacifier either.  She has left him with a sitter and a bottle,
does the same thing there, hours at the bottle just happily drinking the run
off.  

He has an appointment to see Pulmonary as he had some very noisy breathing,
lots of spit up and choking at around 1 month old.  Went to see GI
specialist, but mom passed on the "drop a scope and have a look" plan (they
said she could even do it herself), but she did not think it was necessary.
Pedi at the office suspected trachiomalacia/laryngialmalacia ?? both terms
were bandied about verbally and in the chart.  Mom is not sure she agrees. 
It has taken so long to see Pulmonary he seems to have outgrown his noisy
breathing in the last few weeks.      Mom breastfed her daughter no problem,
had lots of milk. (her daughter was a very very chubby baby, according to
the peds.  Her current infant is more in line with what they expect to see).

So in short we have some funky anatomy, strange nursing pattern coupled with
an experienced patient Mom, with tons of milk leading to a happy (in spite
of the gas) well growing baby.

he needs some suck re-training, IMO, but I am unsure as how to proceed.  I
have some pet theories and plan of attack myself but would like input from
the great lc's of lactnet before I give my two cents.

Thanks!

Charity Pitcher-Cooper

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