Virginia,

I do think we've been hunting zebras when there were really only horses around.

I think one of the biggest issues was that baby simply got used to having the milk pushed for her, and has taken time to develop her own sucking skills.  Once she was able to suck, I did go back to basics, using s2s, BN positioning, and being sure reflexes were being stimulated properly.  It has taken time, but we are seeing progress.  She is now able to sustain sukling for about 8 minutes, as opposed to 2-3 minutes when she first went to the breast after having been lethargic and finger fed so much.  she is now, 100% breast milk fed, most direct from breast, with only 50 - 200 mls of ebm per day, as opposed to mostly ebm/formula just a short time ago.  diapers have been good, and there has been an average gain of 41g per day over the past week.  So we are definitely making progress.

during my 2nd exam today, I realized there is a very mild PTT, but she has pretty good mobility, so I don't think it is much of a factor.  also, during my 1st visit, when baby was 1 wk old, I noticed some very subtle signs of musculoskeletal issues.  I had recommended body work, but mom has not gone.  Now at almost 1 month of age, these signs are much more pronounced, perhaps even to the point of a full torticollis, and mom can see them.  She will be seeing both an osteopath and a CST this week.  The CST is also an experienced IBCLC, so we will be asking her for a 2nd opinion on the tongue and oral cavity.

Thanks for your input, it is wonderful to be able to draw on your wisdom!

Jennifer Welch, IBCLC, LLL
Montreal

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