I was asked to consult by a colleague today on a 3 month old boy. Mom gave me permission to post. This is the third baby for this family and the other two were breastfed successfully. Mom began to experience severe pain within the first week and was diagnosed with thrush. Treatment took 2 months as mom was not given diflucan until well into the second month. When the thrush resolved and the pain persisted, so mom saw an LC who referred her for CST. It was also determined that the baby was tongue-tied and the frenulum was clipped. 

While the mom managed to breastfeed exclusively through the pain for the first 10 weeks, she has been using bottles for the past 2 weeks to manage the pain. Now the baby is refusing the breast completely. 

Here is what I gathered and observed today:
Mom's latch is not asymetrical at all--baby is not tipped back, nor pulled in close to the chest, but attempts to correct this were refused by the baby. 

Baby is being fed with an Avent #1. What he does with this bottle is very odd--his mouth is very wide (his head is much narrower toward the top--the birth was very rapid)-- and he used to move his jaw side-to-side rather than in excursion. He no longer moves side-to-side after the CST, but his jaw still has little mobility. He pulls his cheeks inward close to his mouth to hold the bottle nipple in his mouth, as his tongue does not cup the nipple. Even with the clipping, his tongue is short and remains flat, his palate is high, but broad. 

Baby is receiving only breastmilk and mom's supply is excellent. 

Upon observation, it is as if the baby has too much breast in the top of his mouth and not enough to work with his lower jaw. His use of the bottle is very passive, he swallows a lot of air and seems to struggle with its poisition in his mouth. He does not flange his lower lip or grasp the bottle very far past the nipple.

This mom is heartbroken and just wants her baby to be at the breast. He definately needs a lot more CST and his age makes him more resistant than we'd like. I talked with mom about  correcting latch and being opportunistic in offering the breast, using co-bathing and sleepy periods to get him on the breast, supplemental feeding in a more breastfeeding-friendly manner, and continued use of CST. I suggestd we switch the supplemental feeding method--either something else altogether or a different bottle nipple. 

I only spent aboiut 15 minutes with this mom, but would like to offer her any support I can. Any ideas?
Jennifer Tow, IBCLC, CT, USA

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