Hello all,
I am looking for some guidance with a dyad that has me stumped.
I first saw this mom when baby was 3 months old. Mom had already seen 2
other LC's since baby had not latched from birth. The first LC noticed a
tight frenulum. Mom took baby to pediatrician and asked to have tongue
clipped. Pedi reluctantly clipped the frenulum, all the while telling mom
that tight frenulums do not affect breastfeeding. Baby did begin latching
but was still not transferring milk at breast. Mom continued to pump and
saw the second LC and was told that baby could not groove his tongue and
there was nothing to be done. Mom called me at that point but was so
frustrated that she did not want to have a consultation, just basically
wanted to see if there was any hope. Without seeing baby, based on moms
description of situation, I suggested CST. About 1 month later the mom
called to request a consultation. She had had several CST sessions with
some improvement but baby still not transferring more than 1oz at breast
(Mom rented a Baby Weigh scale). At that point, baby would latch for 3-5
min and then cry and refuse breast, at which time mom would give pumped milk
in a bottle. Upon observing a nursing session, it appeared that baby was
getting distressed when as soon as MER occurred. It appeared that baby was
not able to elevate the back of the tongue. Mom reported that bottle
feeding typically took 30-45min, so baby was struggling with bottle as
well. I suggested mom have baby evaluated by an ENT to check the frenulum
again. The ENT found that the frenulum was still restricted. He clipped
the tongue again at 3.5 months. Now, 2 weeks later, Mom has been
doing "tongue exercises" to re-train baby on how to move tongue. Baby has
one or two feedings where he seems to latch well and is not distressed, but
most feedings are still a struggle. Mom has tried giving only breast for 3
days but baby lost 3oz and was very unhappy. We tried offering a bottle
first with a reduced amount of breastmilk, hoping baby would finish at the
breast and begin associating the breast with fullness/satisfaction. After 4
days, baby had lost 2oz and was beginning to refuse the breast. We tried
having mom take a weekend "nursing vacation" in bed with baby doing lots of
skin-to-skin. Mom reports baby alternated between crying and sleeping,
barely nursing for 12 hours, at which point she gave up and is now back to
mostly pumping and bottle feeding, offering breast a few times per day to
keep baby interested. She is very discouraged and is at her breaking
point. This is baby #4. Baby #3 never latched and she pumped for him for 8
months. She is very frustrated to see the same thing happening again,
despite the time and effort she has spent to make it work.
Any advice on other things to try to help this mom?
With thanks,
Mellanie Sheppard, IBCLC
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