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I just saw a wonderful presentation at our WIC by Barbara Wilson Clay on
latching on. If the nipple is coming out pinched, then the latch on is
not right. It might look ok from the outside but Barbara said the nipple
is not far enough back in the mouth. I would suggest the asymetrical
latch where the nipple is put on baby's nose or under the nose and let
him open wide and come up for the nipple. So more of the jaw is smooshed
into the breast. You could also have a jaw clencher but these babies
usually have the tight lips and the fish lip or pucker up kiss type of
lips. Not a wide open U at the corner of the lips.
Baby might have a tongue tie in the posterior end that is easily missed
except for mom's pain. If he does not have enough tissue into his mouth,
he will get reduced milk flow because the jaws pinch in the wrong spot.
The jaw needs to be smooshed into the breast because it does the work
and if it is hanging out away from the breast, the baby is going to
clamp down or use its gums to milk the breast and hang on.
If the weight gain was better I would suggest maybe a too fast MER
because of the pinching and the unhappiness at the breast (with the good
weight gain). These babies are often unhappy at the breast and stay on
forever because they are looking for comfort sucking and are fussy after
nursing. I have seen many like this slide down to the tip of the nipple
and "bite" to stop the too fast flow.
LLLI says normal weight gain is 170 grams or 6 ounces per week and if
this baby gained only 220 in the last two weeks that sounds low to me.
If mom is in severe pain and you are using the asymetrical latch with
the chin smooshed into the breast, she may need to pump every other
feeding and use a wide based bottle, slow flow nipple for those
feedings. Make sure she has large enough flanges or this could be
pinching her nipple and contributing to the problem. If baby can not
open wide enough on something like an Avent, or wants to tip suck with a
tight mouth on the Avent (lips below the wide base or just up to the
wide base), this leads to a jaw clencher where CST helps. Some babies
clench so tight there is a white ring around the outside of their lips
on the breast and bottle. You can see the tension in the muscles of the
face.
When I am not sure what is going on, and test weights show poor intake
but mom can pump more than baby's intake at breast, I watch the baby
bottle feed (if already getting bottles) because I can see how the lips
grip the bottle nipple and it tells me a lot (either too tight with too
much tension, or too loose where one lip is not gripping at all).
Can mom pump more than test weights show for intake? If yes, the leads
to an oral motor problem or tongue tie.
She's a trooper for continuing so long! Hope this helps, Kathy Eng, BSW,
IBCLC, Houston, TX
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