Summary: the (first-time) mother had flat nipples (not the flattest ever) 
and an anxiety disorder.  The baby was born by c-section at 41 wks healthy 
and without apparent trauma, but proved unusually incapable of learning to 
cope with mom's flat nipples.  We tried positioning & latch, nipple 
eversion, hand expression into baby's mouth, nipple shield, and (at 11% wt 
loss on day 3 plus maternal collapse) two bottles of formula.

The first weird thing was how incapable this baby was of learning to 
latch.  Usually after a few times they get the hang of it even with flat 
nipples.  Not this boy.  He made some progress, but he was *really* slow 
and *really* upset about it, though clearly giving it everything he had.

The second weird thing was that given his problems with the flat nipples, 
once he was given a nipple shield I thought he'd go right to town and 
instead he hated it.  Cried even harder & spat it out most of the time 
(short and standard sizes both).  The bottles were given after we found out 
that he couldn't nurse any better with the nipple shield than without.

His tongue was fine.  When I checked the rest of his mouth I came to the 
third weird thing.  First, his hard palate had a seam of tiny ?Epstein's 
pearls? right down the center.  Couldn't see how that would make a 
difference, but it was new to me.  Hard palate otherwise seemed 
normal.  The soft palate was another matter.  I couldn't see his throat.  I 
mean, this baby was crying hard, and all I could see in the back of his 
mouth was the velum.  It extended pretty much all the way down to the same 
level as the root of his tongue.  When I really peered down his throat I 
could just barely glimpse the uvula.  It wasn't split, but it wasn't 
normal, either.  It was this teeny tiny pointy triangle maybe 3mm long.

I pointed it out to the nurse on duty and to the physician, who didn't 
respond noticeably.

Is this a variation of normal?  Or is this configuration contributing to 
the baby's problems?  The mother is doing a great job, but it might be 
helpful to her to know what to expect of this baby in terms of how 
efficient he is likely to get in the long run.  It's day 11, and the good 
part is that he's fully breastfeeding.  *But*, it takes him an hour every 
time.  His diapers are good.  A post-discharge wt check last week showed a 
gain of 2.5 oz (on breastmilk) in 3.5 days.  I'll see her Thursday and I'll 
get a better idea then of whether this baby is just a 24-hour-a-day 
suckler, or if he's genuinely inefficient at milking the breast even now.

Elise Morse-Gagne

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