An update on my mom and her now 4 month old baby who has been getting
pumped EBM from a bottle.

I saw mom and baby twice. First time we discussed possible approaches to
getting baby to go back to breast. I had mom offer the breast about
halfway through a feeding and baby would not even begin to latch. We
discussed possibly using a nipple shield to get baby to latch as well as
other ideas usually suggested for babies who are nipple confused and/or
nursing strikes.

This baby was originally seen by an IBCLC after losing a pound from birth
weight at one week. The baby had two weeks of suck training with
finger/cup feeding. Baby had a profound tongue "hump" during feeding and
this LC reported never having dealt with such a pronouced 'case.' Mom gave
up after about two and a half weeks because she was spending two out of
every three hours feeding and pumping and suck training baby.

I was able to get baby to take a finger and the tongue does not seem to be
bunching up now, and her latch on a bottle nipple is nice and wide, but
her upper lip curls (her lower has a beautiful flange). Her tongue is
visible cupping the base of the nipple, but she does do a bit of 'gumming'
the bottle nipple.

Mom picked up a nipple shield today and I saw her and the baby this
evening. The baby had just woken from a nap and was very hungry. Mom's
nipples are a bigger diameter than the shield we have and the nipple
doesn't actually 'fill' the shield at all, but we used the pump to get a
bit of milk flowing into the shield and then tried to coax baby to latch
on but the baby was very fussy and pulled away. Even if the nipple went
into her mouth she did not attempt to suck.

We went ahead and had the baby take her bottle with mom feeding her next
to her breast, but the baby was also fussy during the bottle feeding.

When I left the mom, she was still planning to try offering the breast
after allowing baby to fall asleep on her lap in a 'ready-to-nurse'
position. I suggested she let baby sleep in her lap, then try offering the
breast while baby was asleep-- waking the baby with the breast so to
speak. She plans to try this both with and without the nipple shield. She
also had a friend suggest putting powdered sugar on her nipple to perhaps
entice the baby to latch. I think at this point anything is worth a shot,
and at 4 months a small amount of powdered sugar shouldn't hurt.

I suggested that if these things don't get baby to latch she should try to
contact the local lactation center and see if any of the LCs have had
success with an older baby. If anyone is local to the DC/MD/VA area (we're
in Gaithersburg, MD) please contact me if you know of someone who I could
refer her to.  This mother is so committed to breastmilk, but she is
wearing out on the pumping at this point. Her supply is still plentiful,
and I think she just needs someone with more tricks in their bag than I
can offer.

Thanks again to all who gave suggestions.

As a side note, we were using an Avent shield-- is there another shield
that would 'fit' a wide nipple that is readily available? I looked at the
Medela website but the shields look identical to the one we have, very
narrow area for the nipple.

Sincerely,

Heidi Streufert
Gaithersburg, MD

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