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This is a response to the long post on Mellanie Sheppard, on the 4mo baby unable to transfer milk, and whose older sibling also had problems feeding.

When completing my MA a few years ago, one of older women I interviewed about her experiences as a young mother in the 1940s/50s had problems getting all her babies to transfer milk.  No diagnosis was made (that she knew of).  Though initially lack of supply was suspected with the first baby, supply was actually not a problem.  She hand-expressed her milk for her next three babies for 8 months each.  She learnt to be a very efficient hand-expressor.  Her doctor told her not to express with subsequent babies and to feed them artificially, as he thought he was "saving" her a lot of time and effort.  She had really wanted to express, but thought that was "doctor's orders", and she went home and cried.

What I'm saying is that occasionally a milk-transfer problem will occur in families, and sometimes defy diagnosis.  Protecting the supply and providing the EBM by other means keeps this mother-baby dyad's options open, while enabling the baby to receive mother's milk - just as the mother is doing.  While this isn't as good as taking the milk through the action of breastfeeding, giving the baby the chance to take the breast in his mouth most days, and keeping this experience pleasant, will keep the option open of going to the breast at some later time, if this becomes possible.  Meantime, lots of skin-to-skin will help raise oxytocin levels in both mother and baby and provide a reward for this interaction.

This Mum needs reassurance that she did a great job pumping for her previous baby, and that this shows she can do it again for an extended period, if needs be.

Finally - and importantly - I would suspect that this baby may have a constellation of problems, some of them perhaps very slight, of which the tongue tie was the more obvious one.  Could it be that there is *a syndrome or sequence* here, perhaps Pierre Robin without the cleft palate, or with an incomplete cleft of the soft palate that can be easy to miss?  As with most syndromes, there can be a wide range of individual variation and not every baby will fit the usual visual image of the syndrome.

Virginia Thorley
in sunny Brisbane, Queensland, Australia
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