Sorry for the long post...

PTP - mother and baby in office for second follow up visit.  History of inability to latch in hospital, mother hand expressed and pumped to bring in a nice supply.  Nipple shield used to assist latch once mature milk supply surged.  After practicing with the shield, baby has had success with starting to wean off of the shield.  First follow up visit was 12 days ago.  As baby nursed, she seemed to be "calmly" protecting her airway.  No other signs of distress like brow furrowing, gulping, color change, etc.  She would suck once or twice, swallow, and rest.  Repeated this the whole feeding even with compression.  Oral assessment notes a fairly tight labial frenulum, and possibly a posterior tie, but not nearly the worst I've seen.

Follow up yesterday (11 days since last visit -- obviously, I wanted to see her earlier...).  Baby gained 11 oz. in 11 days (same scale), but only 2 oz. in the last 4 days (doctor's scale to my scale -- possibly accounts for difference in scale or is baby slowing in gain?).  Mom puts baby to breast all day and gives a bottle in the evening when Dad is home.  Baby latched in the office to both breasts without the shield, but continued to close her eyes, suck once or twice, swallow, and stop.  No extended sucking burst was seen throughout the visit.  Transfer of milk on the first side was an ounce even with ineffective sucking bursts.  Mother states baby nurses like this with each feeding, says she "snacks" all day long.  Reassessed lip and tongue, same assessment as before.

Here is the interesting part -- as baby sucked on my finger (no fluid), eyes remained open and baby used a very normal sucking burst... for an extended period of time.  Suck was rhythmic, tongue cupped finger, no uneven pressure to any parts of the tongue.

So... what other potential issues could cause this little one to seem to protect her airway?  Discussed potential for tight frenulae to cause the issue, but just wanted to be sure I am not missing something else.  My worry is that her nice milk supply is driving the weight gain so far, not the baby's suck.  I told her to continue using breast pump for stimulation, use laid-back positions to let gravity help with the flow, and follow up with me again within the week.

Thanks for your input!
Trish Wierenga, BSN, RN, IBCLC

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