Rachel

Read your post today with much interest.  If this were my client I'd offer
two alternatives you have already thought of: 1) use of nipple shield, or
2) finger-feeding - and even a third - 3) use of a bottle with a rounded
teat to "suck-train" this baby's tongue to stay down.

I don't see problems with reduced supply, or a need to pump, with the
nipple shields I use (Pur, silicone, very fine, rounded teat - ie not like
that Avent/Medela ones I've seen, which are much firmer and cone-shaped in
comparison).  You could give anticipatory care if you are away, about
feeling if breasts are drained, checking baby's output and weight gain,
pumping post-feed if necessary, but maybe not essential
....    Finger-feeding is very handy - Dads love to do it, and you could
suggest that mom try breastfeeding direct once or twice a day while baby
learns to keep tongue down.  Ditto if bottle-feeding EBM.  Living in a
place where bottles are only used as a last resort (when there's already a
breastfeeding problem) I don't see bottles as the problem - the tongue is
the problem in the case you are working with, and a long, rounded teat on a
bottle would "teach" the tongue to groove around it, and keep the tongue
forward.  It could take only a few feeds with something long, firm and
rounded for the baby to learn what to do.

Best wishes

Pamela Morrison IBCLC
Harare, Zimbabwe
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I'm hoping some of you will be reading Lactnet today and may be able to
help.
Trying to get a baby latched who has trouble getting her tongue under the
breast. Baby is 5 days old, term, healthy and weighs about 6.5 lb (just
under 3 kg). Before yesterday had not opened her mouth wide but is now
doing that fine after some minor position changes. Mother has ample milk
and is maintaining supply by pumping as latch is painful. Baby is being cup
fed.
There is no tongue tie, and baby can get tongue past lower lip, but it
doesn't happen when she is gaping wide to latch - at least not yet! Her
tongue looks a bit short to me, but moves freely and the frenum is not
attached near the tip.
We aren't allowed to let babies suck on our fingers any more, but father's
nails were short and he let baby suck on his little finger while she lay
across his knees, face down, and after about 20 minutes he reported that her
tongue had moved forward quite a bit from its original position where she
was tickling his fingertip with it. Attempts to latch after that were still
painful as baby retracts tongue again at the breast.
Shields have not been tried. Discussed them with mother yesterday as an
option to achieve painless latch, but pointed out that they may not help
baby learn to bring tongue forward, and that continued pumping would be
advisable if shields are used. She preferred to wait at least one more day,
as she feels baby was making progress in the course of Saturday p.m. I
support this choice, and have tried to emphasize that we have time to sort
this out, even if it doesn't happen before she goes home.
Finger feeding is one thing I am considering, but it is really not done here
and I've never followed anyone who has tried it, and I am leaving town next
Saturday for about 10 days (for the Pacific NW, YEAH!) so won't be here to
follow up in any case.
I have the day off today but will be seeing her Monday, and would be
enormously grateful for any suggestions, tricks, anecdotes, ANYTHING that
might help this dyad.
Rachel Myr
Kristiansand, Norway

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