Looking for any further suggestions for mom with large diameter, somewhat  
flat nipples, very inelastic, hard nipple core and baby with very early,  
hypersensitive gag reflex which combined have made breastfeeding not possible  
for now.  Baby had posterior, lingual tongue-tie and upper, labial tie  
clipped which made bottle feeding with Haberman with shorter teat possible on  
day two.  Mom is using the cherry shaped German nipple shield and her  
nipples fit but do not extend very far into the shield.  Have tried the  larger 
A---- brand shield but this gags baby so the more bulbous shield she is  
using is better as baby will latch and suck but then habituates.  Tried  filling 
the shield via curved tip syringe in hopes that she would continue to  suck 
once milk was gone from the shield but this didn't work, she stopped  
sucking.  Tried feeding tube under shield with syringe to give boluses but  baby 
only sucked the nipple part of the shield to get this milk and mom felt no  
drawing in of her nipple as she could when there was no milk in shield, 
though  those few drawing sucks did not produce milk transfer.  Baby cannot 
latch  to bare breast due to gag.
 
For gag de-sensitizing tried CW Genna's exercise and finger feeding with  
syringe and tubing so milk flow decreased gag but baby gagged and resisted  
both.  Have instructed mom to continue trying both of these and suggested  
CST from the beginning which I hope she'll follow through with.  I hope a  
tincture of time and baby's mouth growth will enable breastfeeding but this is  
for now a real oroboobular disproportion situation.  Mom has copious  
amounts of milk and is pumping and I've told her of another case where mom  
finger fed for about 3-4 wk until baby could handle her mom's large  nipples.  
She is discouraged so am offering frequent support, just wish I  could help 
get baby to breast sooner for mom's sake. This baby is 11 days old  now and 
thriving.
 
Would welcome any suggestions or info on similar cases.  Thank  you.
Barbara Latterner

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