This seems to be my month for challenging situations.

I need some collective wisdom. Here's the scoop (with mom's permission)

Mother's nipples well everted, breast tissue and nipples elastic; nipple
size WNL, large breasts
    First baby never nursed well, "just never latched on well, I pumped a
month and then gave up"
    That first baby had a pacifier and rubber teats and mom was careful
about super stimulus etc this     time
    Now pumping 3-5 ounces without difficulty, eight pumping sessions/24 hrs

Infant
    Birth weight 9lb 2 oz, boy Born via c/s after long labor with epidural
at 6 cm (by then
             > 30 hours of labor -- third baby)
    Three weeks old today, 10-1/2 pounds on expressed milk and a very few
formula feeds

    Baby went to breast within an hour after birth -- perhaps two decent
latches in hospital,
             always in football hold with deep asymmetric latch
    We supplemented with Mom's Own expressed via cup -- mom & baby
discharged with
             mom pumping to stimulate supply, she was sick of being in the
hospital and she had
             a postpartum doula who was a LLL Leader

    Today - we again tried deep asymmetric latch in a transitional hold.
Baby screams when
             he comes to breast, mom has been holding him close to her
breast without trying
             to latch him because it seemed he was developing an aversion.
No latch achieved.
             >>Tried cradle hold, he finally opened wide and latched (after
many tries) for perhaps a                     minute - and then "fell
asleep" ; when  we detached him he screamed furiously.
              >>Calmed with a finger. Tried cradle hold with nipple shield -
would not open wide                         enough.
               >>Went to football hold with and without shield.

            This baby probably nursed for a total of two minutes, never
settling or suckling well.

            Digital suck exam was interesting. This baby has the longest
tongue I've ever seen --
            he can stick it way out, probably 1/2 -3/4 inch beyond gumline.
When I placed a
            finger in his mouth -- I don't know where the tongue went. It
wasn't hiked up in the back,
            it came just behind gumline as he sucked. Palate is nicely
arched but maybe a little longer
            than most. Mom says her last baby also had a long tongue.

            Baby slops milk out of his mouth with his Avent nipple. (Which
parents are now using
             to feed him.) We calmed him down with 1/2 oz by bottle
            >>Tried again with nipple shield in cradle hold. Still no
success.

I tried the archives - we have been remarkably unhelpful with these cases
over the years! I suggested to mom that time would probably help as the
mouth would grow. That seems to be the only advice we've given about these
babies.

Any other tips? Is there something I'm missing?  (And where is my edition of
Wolf & whoever? Probably under my bed!)  Why is the tongue so different in
the two different places?

Thanks!
Dawn Kersula
Brattleboro Memorial Hospital

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