Dear Lactnetters,
One of my clients brought me wonderful news this week.  I saw her third baby
11 weeks ago. Baby had already been seen by three other LCs because she
could not latch.  There were no aversive behaviors. Baby was eager and
alert. She'd been born at home with no drugs to a consciencous mother who
had nursed her other babies.  I found a baby with a posterior tongue tie,
small lip opening, small oral cavity, high palate who also had difficulty
with the Avent bottle being used.  I recommended switching to a standard
slow flow silicone Gerber nipple - which fit in her mouth with lips flanged
up to the cap - and paced feeds in a sitting position with support of neck
and shoulders and touching chin and saying "open".  Comfortable feeds
without gagging and choking occurred immediately. Mom was provided with a
good pump and instructions for building a good supply. I also suggested
putting baby to breast daily to keep baby familiar, and to keep the immune
factors in mothers milk specific to baby's needs. The pediatrician took
another look and concurred with my assessment. Baby then saw two pediatric
ENTs. The first concurred but wanted to clip the frenulum in the hospital
under general anesthesia. The second didn't think anything was wrong since
baby could bottlefeed.  Parents chose to pump and bottlefeed because they
feared the anesthesia.  All went well until the 10th week when they visited
family members who were critical. Moms milk supply began to decrease.  She
tried many suggestions with little change and was so sad that one day she
asked her oldest son to pray with her that his baby sister would learn to
nurse.  She began putting baby to breast more. Baby had never refused, but
had never actually nursed before, just mouthed the breast. Over the next few
days she began to feel that nursing was happening. Baby didn't want the
bottle afterwards. There were lots of wet and poopy diapers - even more than
usual!  She phoned me and asked if I believed such a thing could happen .  I
sure did believe and invited her to my office to do  pre and post feed
weights and because I wanted a chance to see this for myself. Sure enough,
baby gulped loudly on both sides. I wanted to fix the latch and positioning
which would be considered very poor - but mom was very happy and baby was
very happy - cooing, smiling.  She took over 4 ounces!  Besides the good
prayers, I believe this happened because mom kept a good supply, made sure
baby stayed familiar with the breast - but never forced her, never shoved a
bottle in her mouth- but always waited for a wide-open mouth and made sure
the lips were flanged, and mom had very elastic nipples and areolas and good
milk ejections.  The baby's chin is good but the tongue barely covers the
bottom gum.  This made my week! I've had so many non-nursing babies for
various reasons recently.  Just had to share.
Anne Grider, IBCLC

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