Dear Jane-
     Thank you so much to all who wrote in with their suggestions.
      I am hoping that this is one case where the "tincture of time" as the
baby  grows and catches up will heal.
     MER definitely occurs as the baby is at breast as the mom is dripping
with milk. Pamela's mother who doesn't "let-down" to her baby is very
interesting, and I'm glad that her psychologist is exploring that with her.
     Baby has a bit of a bubble type palate, but not so much that I would
expect no transfer at all---esspecially because moms breasts are  soft.
     I found no anatomical anomolies in the baby's mouth, although couldn't
see very well waaay back there.  But another baby I worked with with a timy
cleft on the uvula had feeding problems overall.  This baby does fine with
both bottles and SNS---it's just mom's breasts that she has  trouble with.
     On digital exam, baby's tongue makes peristaltic motion, and there is
some suction, although not a lot.  But again, I've seen babies with less
suction transfer more milk, especially when mom has a good milk supply.
     Mom has finally wearied of all this.  With tears and trepidation, she has
decided to stop for now.  No more SNS, no more test  weights.  She wants to
pump some to keep things going and give baby some of her milk.  But she and
her husband (and baby) will be away for a month visiting family beginning this
week, and she just can't cope with all the rigamarole with no results.
    She does not want a feeding consult from a speech or occupatinal therapist
right now.  There's no way to get one before Christmas, and she and her family
leave the day after.  Emotionally, she's had enough of everything for the
moment.
     Our hope, mom's and mine, is that in time, this baby will "get it".  She
plans to put the baby to breast whenever she and the baby want to---for
comfort, for cuddling, to maintain breast familiarity.  And she's hoping that
at some point her baby will actually get milk from a breast.   (What a
fabulous idea!)
   Thanks again for sharing your input to help this mother and baby.  And I
wish all who celebrate a blessed, enchanting, peaceful, loving, merry
Christmas!
      Debi Page Ferrarello, RN, IBCLC, in Abington, PA