I have permission from the mother to post.

Long story. Saw baby at 3 weeks, mom says "not enough milk." Observed baby,
found moderately tight frenulum. Mother VERY distracted by 2 yr old. Kept
getting up, to tend to her (she was *fine*) during breastfeeding baby.Baby
poppin off every time. Baby latched "OK" Mom had slightly delayed MER, but
baby gained 3.5 oz (Medela elect scale) in about a 20 min, both side
nursing, using the first breast twice. Mom was using about 6 oz ABM sup a
day at this point. I showed her Compression, better latch, leaving the baby
on until several MERs occured, and tongue exercizes. Gave referal to MD I
use who frequently performs frenotomies, told mother it was essensial he
evaluated. Left her with a pump, instructed to pump every 2-3 hours, after
each nursing. Showed cup feeding for sups, left instructions for reducing
sups as milk catches up. (Baby does NOT like the ABM!) Baby had gained 10
oz a week since lowest discharge weight. Told mom I had to weigh him in 3-5
days.

One week later. Mom didn't call or set up weighing appt. I couldn't reach
her. Was temp living in family member's home while home was being painted.
Asked if she had seen MD for tongue. Nope. Asked if pumping. "It's hard,
someone will hear me." (?)Claims pumping "about 4 times a day" In the
*bathroom* at her brother's home! Asked if using tongue exercises to help
stretch. Nope. Toddler makes it "too hard." Baby now up to about 10 oz ABM
a day. Told her I NEEDED to weigh baby. Told her she NEEDED to see MD.

Send report to MD. Mom said it was "too far" to come to me for weighing.
(It really is moms' responsibility to come to me for a weight check. I
don't charge for them. I thought a follow up consult would be useless until
MD was seen.) Told her we would recommence after MD visit, but I really
needed to weigh this baby. Tole me she would have MD weigh. Two days later,
She finally Saw MD, he said "It isn't bad enough to snip."
(ARGHGHGHGHGGHGH!) MD did not weigh baby, although I really stressed that
she should ask him to. She "forgot."

Mom is not keeping adequate records, says she "thinks" baby is having 5-6
wet and one big poop a day, (he's 5 weeks now) says pumping 4-5 times a
day, 20 min, getting only 1 oz. Refused to try galatagouges. Tried to
schedule an other consult. Said she would "Try" to pump more and "wait." I
said, "Don't 'try' DO it!" Asked her to please come in for weigh. She
didn't.(Again the fact that she has a 2 year old is used to excuse lack of
compliance.)

Yesterday, called in a near panic. Yet not much has changed. Still not
pumping enough.  Thinks she is "losing my milk." "baby is needing more
formula." Yet still using the *same amount* of ABM he was over a week ago.
When I pointed out that *I* was keeping records, and that she is using the
same amount of ABM as a week ago, she said "Oh." Expalained a baby at her
baby's weight is taking about 30 oz a milk a day, if 10 oz of ABM, SHE is
still providing 20 oz or more. Stressed importance of record keeping. Made
appointment (finally!) for today.

She is going to need a supplementer. I can't count on her to pump. BUT she
is STILL nursing. (Amazing!) This is the only ray of light in this
situation, the fact that this baby LOVES to nurse. She will *not* tolerate
and other referal to an other ENT or ped dentist for this tongue. The
tongue IS working, yet he could be doing a bit better. I also feel he might
get a better latch (mom says he tries to nippple feed, I stressed she
needed to take him off and relatch when he does this.)with a sheild, but
with her lack of record keeping and precarious supply, I am not really
comfortable with shield alone. I KNOW she would use the sheild! But may not
pump to continue supply. I won't know the story thus far until I see him
nurse and finally weigh him this afternoon.

My  hairbrained scheme. Try a shield to see if he latches more deeply.
THEN, Thread an SNS tube THROUGH the hole in the sheild and have her use it
(this contraption) at ever OTHER feeding, and then really stress she HAS to
pump after she does this. Do every other feeding on the bare breast.

This would give him a deeper latch, AND sup him at the same time,
eliminating her bottle usage. I feel with his tongue,and her slow to start
MER he is going to become more dependent on the bottle and ABM if something
more drastic isn't done.

I will watch a feeding and then introduce this thing (Sheild/SNS) I made
this morning. (At about 5:00 AM, because I couldn't sleep thinking about
it.)

I HATE to gadgetize this baby, but he *does* need the supp, at least for
the time being, and a deeper latch will only benefit both of them. (Mom has
told me "how much faster" the bottle feedings go....) But mom does NOT want
to quit.

Input please. I am only doing this, as this mother cannot be counted on to
keep adequate records, seems to panic easily (and then give more ABM) and
seems to have a hard time with compliance. I think she may actually USE
this device, the baby will get more milk, a better latch, and she will be
more stimulated. Her problems with compliance may actually work in their
favor, as she probably won't want to be bothered using this thing at EVERY
feeding, which would be perfect!

Why do I feel I have to justify this plan of attack?

Input please, Wise Ones.

Mary Jozwiak IBCLC, RLC, LLLL, AAPL
Private Practice

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