Hello all,
  Just wanted to throw this out there to see if I am missing anything (permission to share):
  Long story short- first time mom, term baby, vacuum delivery. Baby with significant PTT and latching difficulties immediately. Referred by Pediatrician to ENT at week 1 for frenotomy  but parents opted out d/t anxiety over procedure (despite counseling re: risks and benefits of procedure and effects on breastfeeding by myself and her provider).  Also discussed bodywork for baby but parents skeptical.
  For almost 3 months mom had issues with latch, sore nipples, engorgement, mastitis, supplementation and baby's weight gain. I saw mom a couple of times and revisited PTT issues, bodywork, latch, getting baby back to breast and pumping/supplementing at breast. At 3 months parents opted to have frenotomy done due to continued sore nipples and poor wt gain. Over the next 2 weeks there was an improvement with depth and comfort of latch but, based on pre and post feed weights, no improvement with milk transfer. Baby would be happy only eating 6 times a day, for 10 minutes on 1 breast (although mom had been working on at least 8 times a day pumping afterward with increased supplementation- now bottle feeds expressed breast milk after feedings). Baby's weight has stalled again so mom has had to, yet again, increase feedings, pumping sessions, and supplementation. Mom states it is difficult to keep baby interested in taking in enough milk.
  So, frenotomy was done late in the game and at this point baby has an aversion to suck training and pacifiers (although site seems to be healing well and mom reports she has been vigilant about stretches). The hope, of course, is that she would transfer more at the breast (transfers between 2-3 oz a feeding but needs at least 4 oz a feed- mom able to pump 1-2 oz after feeds) but doesn't seem to be (I see them later this week to re-assess). Mom's issues have improved. But how can I get this baby more interested in eating/draining the breast or eating more often?  I again have discussed bodywork with the parents but they continue to remain skeptical.
  I had mom last week go back to using the SNS in the hope that baby might start expecting/demanding more at the breast. What do you think? Will this baby slowly start using her tongue more efficiently or are bodywork and more exercises the key?

Thanks so much,
Sheila Waterstrat

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