Very difficult case. I forgot to write the details down but basically C/S
birth 5 wks ago after 16 hr labor "failure to progress" I think. Baby was
not nursing well in hosp (don't know details of this) so he got bottles the
first night. ARRGGGGHHH. Then baby wouldn't latch. Acts like "aggressive non
nurser" in Breastfeeding Answer Book but will cuddle upright on mom and
betw. breasts. Will not nurse w/ nipple shield either (like someone recently
said the breast refusers don't usually take to this either). Does not do the
"classic" "nipple confused" behav. either, nor has the usual nip. conf.
correction techniques worked. Positioning etc taught to mom. She is
extremely motivated to bf exclusively.
Noted tight LABIAL frenulum, and upper lip curled in won't flange. ENT doc
agreed and clipped. No improvement. Suggested "babymoon" w/ cosleeping,
cobathing and the usual don't force him techniques. Also to try bf when
walking, rocking, sling etc.
Checked for broken clavicle, hip clicks, clefts, etc. Baby does not seem to
be in any pain. Muscle tone appears normal, i.e. not hypo or hypertonic.
Mother states baby sounds a little congested pc. No nasal blockages. Cannot
visualize uvula as I want to check for bifid uvula which could mean
submucosal cleft. (Should you be able to see this w/ penlight when baby
cries? I even looked w/ a tongue blade and could not see the uvula. Is this
significant? Sorry, guys, I hate to be invasive but at 5 wks mom is at wit's
end.) I did not auscultate chest, but color, perfusion, wt gain is good.
Reports consistently faxed to MD, no abnormal findings per her. Suggested
SNS to give quick flow and reward when baby briefly latches; mom has not
tried this yet, altho she has one, doesn't feel ready to do so, even now.
Referred to speech pathologist who has exp. working w/ bf babies. Saw x 2
visits. Everything found to be normal except sl. receding mandible. Oral
motor function, suck, etc assessed to be WNL. Baby still staunchly refuses
to bf. He will latch very briefly (not w/ shield) and cries, kicks, punches
quickly. Mom is now 5 wks pp and has now accepted my recommendation to see
chiropractor who does CST and works alot w/ babes and children. I also
suggested she may want to see another LC who may help her better than I. I
gave her the names of several I respect. Baby has always and continues great
wt. gain on expressed ebm only. Mom using PNS pump from the beginning.
Any suggestions from you, oh wise ones? Or can anyone send a magic wand my
way?
Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA
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