I have recently had two moms whose nipples were misshapen when they came
out of the baby's mouth despite everything I did to make positioning
"perfect."
Most recent mom--baby over a week old, low supply, baby has had lots of
bottles, but prefers the breast. Baby's jaws were tight on digital suck
exam. Baby breast fed for 50 minutes with what appeared to be very good
latch. We switched him from sided to side when he began doing more
non-nutritive sucking or taking longer pauses. Breast compression
possibly helped a little. Every time he came off the breast, a top view
of the nipple was an oval shape.
After nursing for 50 minutes, baby was crying with hunger. Mom
preferred to take him home (a short distance) and bottle feed him, so I
didn't see how he nursed from a bottle. Mom said baby didn't like fast
flow from bottle. I recommended supplementing with slow-flow bottle
nipple.
History--baby had been hospitalized for jaundice and dehydration within
a few days of discharge. Baby had been bottle fed in hospital
(probably exclusively at first), and mom had pumped. She pumps less now
than she did then. She is using a hand pump, which apparently is her
only option at this time. I recommended that she pump 5 minutes on each
side after evcry feeding (her limit, I think) and that no feeding last
more than an hour--including breast and bottle feeding--this was a great
relief to the mom.
Second mom--I have lost contact, so don't have current information
In hospital, I was called because mom had blisters on her nipples. When
I saw her, the "blisters" were very small.
At breast, baby was doing mostly non-nutritive sucking. Taught parents
signs of correct and incorrect latch, signs of nuturitive and
non-nutritive sucking. Corrected positioning and latch. Mom stated she
didn't think baby had ever sucked nutritively before this feeding (about
24 hours of age). Every feeding was painful. Whenever baby came off
breast, nipples looked like wedges with large "blisters" at tip of
nipple (tip of "wedge"). I told parents to see a more experienced IBCLC
if it didn't get better within 24 hours.
History--epidural, mother said she had been instructed to forcefully
push up on baby's chin to make him suck and had been told to use cold
wash clothes to keep him awake, which she had done as instructed. I
taught her to do breast compression and to use a light touch on chin to
remind him to suck if necessary.
I have been told cranio-sacral therapy would help babies such as these.
I think this is a possibility, but not one I can suggest in my present
environment. I have also been told referral to a speech therapist would
be helpful. I have read everything I can find. I did suggest massage
and swaddling to the mom I saw most recently (see the Breastfeeding
Answer Book).
The Breastfeeding Answer Book also suggests use of alternate warm and
cold clothes to face for clenching. This runs counter to everything I
have learned about gentle treatment of babies. Does this treatment have
a scientific basis?
Will fast flow from bottle nipples or pushing on baby's chin cause this
response? I have heard epidurals named as a cause of clenching. Do we
have scientific evidence? Many U.S. hospitals have extremely high
epidural rates? If that is the cause, why aren't all the babies
clenching?
Please reply privately as well as to the list.
Bonnie Jones, RN, ICCE, IBCLC from the sunny S.W. USA
mailto:[log in to unmask]
--
Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA
mailto:[log in to unmask]
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