Dear Lactnetters:
     I am working with a baby who has me stumped!  Mom is very motivated and
is willing to do anything to make BF work, and I need your help.
    I first saw mom and baby upon pedi referral because baby was still under
birth weight at four weeks.  At that time, mom had a low milk supply, but had
not been feeding frequently enough and baby had been nursing on nipple,
pinching it.  I had her pump after feeding, take alfalfa, use Dr. Jack's
famous breast compression, and improve baby's latch to compress the
lactiferous sinuses.
    Mom's milk supply responded right away, and she now produces enough milk
for her baby, but this baby transfers next to nothing from her breast.  She is
using an SNS.  As I observed a feeding yesterday, she was well-attached, I
could see mom's breast tissue respond to each suck, and she suckled
vigorously.  If I slowed the flow of the SNS, her sucking immediately changed
to a fluttery little suck, then she stopped altogether.  After 25 minutes of
switch nursing and very convincing breastfeeding witht he SNS, she had taken
in 84cc of milk, 82 cc of which were from the SNS!  Mom couls pump ounces and
ounces after.
     Mom mentioned that her midwife suggested a nipple shield with the
rationale that its rigidity would help keep her tongue under the breast.  We
tried that, but that did  not improve things significantly.
     Baby has good lingual mobility, no tongue tie, cups the breast with her
tongue, and peristaltic movement is felt on digital exam.  She does tend to
protrude her tongue a bit when she's not nursing.
     What am I missing?  Any ideas you can share with me to help this
delightful mom and baby will be greatly appreciated.
THANKS!

-Debi Page Ferrarello, RN, IBCLC
Abington, PA