Congenital hypothyroidism? Does the baby have a somewhat large tongue
also? The two can be associated. If the baby is hypothyroid, treatment
is important to preserve cognitive capacity and health.
Catherine Watson Genna BS, IBCLC NYC cwgenna.com
On 9/11/2012 2:42 PM, Riva Weissfish wrote:
> Good afternoon to you All,
> I apologize in advance for this long post – I couldn't find a way to make it shorter. TIA for your indulgence.
> I have a situation that has me stumped and I am not sure if it because it is truly unusual or my expectations are mistaken.
> I saw baby R and her mother the day they were released from the hospital at about 60 hours of age. She was born vaginally with an epidural. Birth was not unusually long, no extended pushing and no other interventions besides the epidural. Baby was not placed directly on Mom but did "breastfeed" a few minutes after the birth. By day 2 in the morning she "was not latching" and had been given a supplement at night. Otherwise she was trying (unsuccessfully) to breastfeed. We worked on waking her up," Biological" positioning, other positions, and paced bottle feeding. I identified a tongue tie, left them with a pumping plan(which is working out great) , trials of breastfeeding and supplementing with her own milk every three hours – since baby was absolutely not waking for meals. She also was doing STS and some suck training. . Had TT and ULF revision the next day. I saw them again 4 days later. Baby had not once woken to eat on her own and still had not latched. Her weight gain was good so I suggested giving her ( R) a day to determine when she needed meals - hoping that now that she had enough calories, sts and was a bit older she surely would set her own schedule. I suggested they not let her go over 5-6 hours more than once. She still did not wake up and did not compensate by eating more at each meal and took four meals of 80 cc that day.
> She is now 11 days old we have gone back to waking her for meals about 8 times day and will only wake on her own for meals twice a day (in the middle of the night and about 6 hours later) I had them switch to an SNS for both nursing and finger feeds but Mom reports that she will not latch for her (I did get her to latch when I was there) but does nicely with the finger feeds, though it takes longer than a bottle but she can at least get her to suck, making a vacuum to suck in the milk, but always in her sleep. Overstimuation/ avoidance? They tried putting her in a less stimulating environment (quiet, darkened room) to no avail. They returned to STS with Mom, Dad and Grandma. Pediatrician is not concerned about the sleepiness, checked baby and doesn't identify any problem. I felt that by now she should wake for meals as well as eat with open eyes. Her color is good, she is plump and healthy looking and her muscle tone is also good (when you try to wake her she gets good and mad!)
> The only thing I could think to suggest at this point is CST, but since I haven't a clue what the problem is how do I know if CST is the right direction? The family is amazing, sticking with it, trying to get baby to latch throughout the day. Could it be she is hooked on the finger feeding? We tried a silicon nipple to give her a more similar feeling to the finger /bottle but she simple doesn't open her mouth. She is ASLEEP! She cries and gets angry when stimulated and as soon as she snuggles into her mother she falls back asleep. I keep thinking that she will wake and be more alert with the time but do not want to miss something important going on here.
> Any suggestions? Am I missing something?
> Thanking you for your patience if you read this far you must be very devoted and patient –waiting for your insight
> Riva Weissfish BA,CCE,IBCLC
>
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