I have had 2 interesting cases this week--one very frustrating, I'm afraid.
The first one was a mom who called looking for a supplementer which someone
told her to get b/c her baby was so frustrated at the breast due to nipple
confusion. I made a home visit and found that the baby had a difficult time
placing his tongue properly beneath my finger. Mom had blisters on the tips
of her nipples (on the phone, she told me "the baby latched on beautifully in
the hospital, but kept losing weight and no one knew why so they gave him ABM
in bottles (told her afterwards) and then continued to give bottles, but when
she asked to pump they told her she could do that when she went home". She
also told me he clicked all of the time in the hospital. Her milk came in
late on day 5 (induction, ceserean, mag sulph, poor stimulation). She was
pumping w/ one of *those* brand pumps and was getting very little milk and
feeding with a bottle (mostly ABM). Upon visual assessment, I found the
baby's tongue, even in an upright position, did not reach past the gumline.
The frenulum looked rather fleshy as well, so I was concerned that this would
not be a simple clip. She tried him with the supplementer anyway and he could
not effectively grasp the nipple. She was, however, thrilled to have a way to
feed the baby w/o a bottle (supplementer on her finger) and before I visited,
she had gotten a better pump and was getting twice the milk already. She and
her dh were relieved that there was an explanation for their problem. I did
tell her the baby was also clearly nipple confused and that it may take a bit
of time to get him to breast. I gave all of the nuzzling, carrying,
co-sleeping tips and names of ped's who would help her. The next day, I
called and she said her ped was wonderful and willing to work w/ them! Sounds
great, right? Well, it seems the ped told her the baby is *not* tongue-tied
and is just nipple-confused, but that he will work w/ her instead of me. (Her
insurance even covers me). Now, I know I can make a mistake, but this baby is
tongue-tied! The ped told her he would teach her excercises to do w/ the baby
and this would solve her problem. I have a call into the ped now to speak w/
him, but around here most of the ped's are quite arrogant about these things
and become defensive very easily. So, wish me luck! (I am going into the
conversation *assumming* he will *not* be defensive at all).
Jennifer Tow, IBCLC, CT, USA

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