OK, It's time for Latch-on 101.

Mother was induced near due date because baby had stopped gaining.
Wednesday's attempt at induction "didn't take" and the induction was
repeated on Friday, with baby born on Sat. at 5 lb. 11 oz. Placenta was small.

I saw baby on day 4 and she didn't look so good--quite jaundiced and not
much energy.  My alarm went off and said, "Feed the baby!"  Mom had been
trying to pump but had had no instruction.  We got the pump set up and she
got 2 ounces of milk rather quickly.

Upon examining her breasts and nipples, I decided that no artificial teat
should cross this baby's lips.  Mom's nipples are "petite" with a large,
firm breast behind it. (Doesn't sound so bad, does it?)  Mom began spoon
feeding and baby drank all 1 1/2 ounces. Actually, I don't think that it a
problem with mom's nipples because I have seen many that looked like this
and baby fed with no problem.

I checked baby's suck and her tongue was up and back--and she had very
little sucking motion of any kind.  I asked if baby had been suctioned and
she had--vigorously, 3 times. So I concluded that we were working with a
sore throat from the suctioning.  I recommended spoon feeding to help her
tongue to come down when she no longer needed to protect her throat, which
I predicted would be at about 1 week of age.

Mom noticed the baby's tongue coming down and sticking out in a couple of
days, meanwhile baby was looking great and filling out.

So, I came back to work on breastfeeding.  Baby was quite happy with the
spoon feeding and was not eager to suck even a finger, and had not a clue
what to do at the breast.  She liked to be there, which is no small thing,
but there was no rooting or suckling motions.  I decided that we would try
finger feeding with SNS to stimulate sucking. It took her a day or 2 to
grow eager to suck.

Oh, throughout this time I had tried the nipple shield several times and
she never would bring it far enough into her mouth.  She just pinched mom's
nipples, which was quite uncomfortable.  I was using the newborn shield
(turned inward to draw nipple in) , but she wouldn't draw it into her mouth
beyond about 3/4 way.

Here I am now, baby is eager to suck now, but can't do anything at the
breast.  I'm second guessing myself, saying that I should have stayed with
the spoon and not introduced a finger that feels a lot like a teat, but I
was feeling that she was settling in to spoon feeding and not suckling.

Mom is growing discouraged and my "cheer leader" skills are being
challenged. Today I almost suggested a bottle so that mom won't give up.
But she asked if that could possibly delay her progress to the breast and I
said it might. So she said she would stick with spoon feeding.  The finger
feeding with tube was very slow. Why?

Is it time to call in my OT for an evaluation of her suck, or to do some
cranio-sacral work?  I have usually used her for sucking problems at the
breast.  Does anything you have read above indicate a need for a suck eval?
 Or do we just need time?  Baby is only 1 1/2 weeks old now.

Would a bottle be a big mistake?  Have you seen babies who can't use a
shield?  Could her mouth be too small for a shield? Would a couple of you
like to make a trip out to Milwaukee?

Wouldn't it be great to have a hands-on "team approach" to tough problems?

Any suggestions will be greatly appreciated!

Patricia Gima, IBCLC
Milwaukee


mailto:[log in to unmask]