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Subject:
From:
Dee Kassing BS MLS IBCLC <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 17 Jun 2003 14:43:40 EDT
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Dear Lyla,
       You wrote, "I mean one side (right or left) of the lower gunline is
'higher' than the other for lack of a better descriptive word."
       There might be another condition going on here.  The condition is
called hemifacial microsomia.  Fancy Latin for one half of the face (hemifacial)
is smaller than the other (microsomia= small body).  In some babies where the
left side of the face does not grow as quickly, there is also *sometimes* heart
involvement, and then the condition is called Goldenhars Syndrome. (I hope I
spelled that right.)  And babies with heart conditions, especially undiagnosed
ones, have trouble gaining weight.
       My understanding is that the condition usually becomes more evident
over time, as the baby has more trouble eating.  My first exposure to this
condition was when the mother of an 8-month old called because she thought her baby
had gone on a nursing strike.  While we were trying to deal with that, she
also took her baby to a plastic surgeon.  The baby had ear tags on the side of
the face that was smaller (we didn't know it was smaller yet, it wasn't real
obvious!), and the pediatrician had originally wanted to just rubber-band them
until they fell off.  The parents weren't comfortable with that plan, so
instead took the baby to the plastic surgeon.  This was actually a blessing.
Because this baby's condition was not as severe as some, if the parents had allowed
the pediatrician to remove the ear tags with rubber bands, it would have been
much longer before the condition was diagnosed, and then the outcome would not
have been so good.
       Anyway, the plastic surgeon realized at once that ear tags are a
common manifestation with hemifacial microsomia and did some more tests.  (Does the
baby you are working with have any ear tags?)  Within a week, the baby had
his first surgery to help the two sides of his face retain more symmetry.
(Although, baby did not go back to breastfeeding.)  But the reason baby
stopped nursing is because, as the two sides of his face continued to grow at
different rates, the pressure on his jaw was becoming too much to bear while
eating.  The mom gave me more information on this as she learned it.  Seems that at
least in the U.S., it almost always requires a plastic surgeon to diagnose
this condition; peds don't usually catch it.
       This may not be what you're working with here.  But keep it in mind if
other suggestions don't seem to help the situation.
       Dee Kassing, BS, MLS, IBCLC
       Collinsville, Illinois, in central USA

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