I am working with a mom and baby and baby is 3 months old. Baby was not gaining in the beginning so mom was pumping after feedings and baby took a bottle. Milk supply came up to 1.5 to 2 ounces per feeding/pumping and has not changed. Baby has very little to no suction. Baby needed chin and cheek support to improve suction on both bottle and breast. Baby also had several visits for bodywork. Suction has not become any stronger. Mom decided to breastfeed and stop pumping because she was frustrated. Baby gets formula bottle after breastfeeding. Over the past several weeks baby consistently transfers 1.7 to 2 ounces from the breast (exactly what mom used to pump). Baby does better on breast versus finger or bottle, but there is still very little suction at breast.  She tends to flange her lips almost too well if that makes any sense.  A big gape at breast and with the bottle her lower lip actually comes well over the plastic ring. It is like her lips are too relaxed.  She does not seem to have any tone issues otherwise. She uses her tongue to compress to get milk since she is not able to form any suction. Although, she has trouble cupping the tongue. I have thought about a submucosal cleft.  She has little to no spit up and it never comes out her nose.  She does not appear to have paranasal bulges, but she does have what looks like a “gull wing” upper lip.

We had suggested baby have her tongue released, but parents not wanting to at this time.  Her frenulum is submucosal and not sure if it is a true tie. I have worked with quite a few tongue-tied babies and despite all of their feeding problems they could all at least maintain some sort of suction-sometimes too much suction.  I am not ruling out tongue tie for this baby.  I am just not sure what to try next.  She is gaining weight appropriately, but she seems to be getting worse with feeding issues instead of better. The last baby I worked with that could not maintain suction had a cleft of the soft palate.  That is why I am wondering if I am missing something.

Sorry this is long.  It is hard to explain everything in writing!  Thanks!

Christine Lichte, IBCLC

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