I've been working with a mom and baby with suck problems, and now a second
mom has just presented very similarly.

Both babies had difficulty latching from birth.  Both moms developed sore
nipples quickly, with degrees of trauma.

Mom #1 had bruising and crack, and complained that baby was nursing around
the clock (every 30-45 min) and always fussy; regained birth weight before 2
weeks. Baby clicks very frequently. We've worked on perfecting latch
technique and baby does better, but she still isn't able to tank up
completely and will "check out" after a bit.

Mom #2 had bleeding, scabs, crater (and now mastitis on one breast and
plugged duct on the other)-- has mostly been pumping and bottle feeding with
Avent nipple, trying baby at breast daily but getting chewed up; when baby
is at breast, some swallowing with MER, lots of NNS, clicking, then falls
asleep despite abundant milk supply. She only took 34 ccs after spending 20+
min at breast; I thought she had taken in more. She is 11# and can down 5 oz
with a bottle easily.

On digital suck assessment, both babies seem to have low-level peristalsis
of tongue and seem to be overcompensating with extra suction, resulting in
breaks that cause clicking. Both also have white coat on tongue; the first
baby's was light, ped said not thrush; no diaper rash. Second baby's tongue
coating a bit thicker, and has raw diaper rash that isn't responding to
desitin--- definitely yeast there.

While yeast may be one common denominator, I don't think it's the root
problem. Both these babies have struggled from birth to efficiently strip
the breast. Both these moms had ITNs. These babies are full term, healthy
and gorgeous little girls, and as far as I am concerned, there is no good
reason for them to struggle with the basic reflex of suck.  I know epidurals
have been implicated with suck problems--- how many of you have become
suspicious of ITNs?  The first baby is now 3 wks (I saw her first a week
ago), the second is 4 wks of age (I saw her today, she's ready to quit).

I'll be searching the archives for posts, but would like additional input
from any with similar experiences.

Lisa Marasco, BA, IBCLC