----- Original Message ----- 
From: THE FOGELMANS 
To: Recipients of LACTNET digests 
Sent: Saturday, October 02, 2004 10:22 PM
Subject: hyperactive gag reflex


Hello Wise People,
I am puzzled about a baby I am currently working with who has a very hyperactive gag reflex.  I searched the archives to no avail.  Mother has given me permission to post.  Baby was born 9 lbs 2 oz at 37 wks to a mother with gestational diabetes.  This is mother's fifth baby.  All four previous babies nursed for just under two years with no problems.  Mother has always had a copius supply and breast infections at around 2 weeks of age.  The baby was suctioned for meconium as soon as the head was delivered.  Mother had an epidural.  She reported that the baby  nursed well in the delivery room and continued nursing well for the first 6 weeks.   At 2 weeks she had a breast infection. Her pediatrician/husband  prescribed her a very weak antibiotic (she can't recall the name)  which she took for a week.  The infection came back soon after she finished taking it.  She then took augmentin which seemed to do the trick but has had two more episodes - same place in the same breast -  which she self treated.  She says that at 6 weeks old, the baby started making smacking sounds during nursing, was gassy and fussy during feeds, no longer fell asleep at the breast and she could tell that her latch had become shallower. She called me at 9 weeks with the 4th breast infection. 
     Baby was last weighed at 7 weeks and weighed 14 pounds.   Baby has plentiful yellow stools a few times a day.  She is big and happy, very sociable, vocal, interactive.
    I watched a feed and noticed that baby is not latched on at all.  She's basically gulping milk which is pouring out.  She has a hard time dealing with the mother's MER but manages.  The baby's tongue seemed possibly restricted.   She barely seemed to stick it out past her gum line.  Mother says that she has never noticed her baby stick out her tongue.  I tried to do an oral exam and baby gagged as soon as my finger went at all past her gum line.  We worked on positioning assuming that the tongue was restricted.  Baby latched on great in a football hold and immediately gagged.  We tried a few times but after three deep latches which led to immediate gagging she went back to her non-latch.   Mothers breast are soft and graspable, nipples are smallish.  Mother said that they had tried giving baby a bottle and she gagged.
    We tried to figure out what happened at 6 weeks which could have caused the change.  Mother says that she became much busier at 6 weeks which is when the other kids went back to school but she still had mornings free for her and baby.  Baby received her first vaccine at 6 weeks, nothing oral and with no noticable side effects. Mother reports no change in milk supply.  She says that at around 6 weeks she stopped being careful about how she put the baby to breast, feeling that things were going well she got lazy about positioning which was extremely poor when I started working with her.  Still none of this explains why baby seems to have developed a hyperactive gag reflex at 6 weeks old. 
I was thinking that perhaps baby needs to be seen by some other kind of specialist but I don't know what kind. I don't know what else I can do in this situation.  Fortunately mom doesn't have to worry about her milk supply - yet.  I would really appreciate any advice you could give me. 
Thanks in advance,
Chayn Fogelman IBCLC Israel


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