Hi all
I saw a very confused baby today and wonder if anyone can give me
some suggestions. Baby is 3 weeks old, barely back to birth
weight and has never really had a satisfactory feed. Born at 37
weeks, epidural but no other intervention. Not suctioned, roomed
in with mother. Seemed very 'fussy' compared to her last two who
fed with no problems. Mother realised after 2 weeks that this baby
was hungry, few bowel actions but urine output ok.
I watched baby feed today. Gapes wide, takes breast but then
fiddles around, lets go, gapes again etc etc. MER happens quickly
but baby still doesn't latch, even if milk dripping off nipple.
Breast/nipple both average size and shape.
Obviously manages to get just enough to avoid starving, but
very unsettled and frustrated. Tried different positions etc
with no result. Baby not at all keen on digital exam, tended to
cry and hump tongue a little, although did one quick burst of
normal sucking. Palate is normal, no tongue tie. Doesn't gag on
finger, just seems not to know what to do with it.
Baby has been well since birth, no jaundice, checked by Ped who
felt all was OK. Mother is well, experienced breastfeeder who
can tell baby is just not latching. She is presently pumping and
bottle-feeding to get some milk into this scrawny little thing.
I have discussed cup/finger feeding to get some positive feedback
to this baby. Mother is also going to try co-bathing to get baby
more relaxed and willing to try to latch. She has also considered
using a nipple shield but I'm really not sure if this would achieve
much.
I'm stumped as to why this baby is having so much difficulty
getting on to the breast, and would appreciate any suggestions
or insights.

Fiona Coombes
Family Physician, IBCLC
Perth Western Australia