Dear friends,

I saw a mom and baby yesterday.  Baby is nine days old.  Birth weight 9#11oz
weight At office on Friday was 8#5.9oz  Baby seeing PA in Family Practice
office, she is not concerned about weight wants to see them again at one
month.  Mom is concerned ( and rightly so IMHO) the CLE who works with me
saw them on Friday and sent them home with a starter SNS after test weigh
showed little to no intake after nursing.  I saw them on Monday weight is
8#8.4oz.  Mom giving one ounce in supplementer with daytime feedings.  Ask
to observe feeding.  Mom has very long (1 inch +) nipple with very small
areola and small breast.  Baby latches and starts sucking but only tongue is
moving ( seen under chin) no temple or ear movement and very little
swallowing.  Took .3oz  nursing from both breasts for about 30 minutes.  Mom
was massaging but unable to do compressions because breast too small ( hand
in way of baby latching)  Mom says he nurses better ( still takes a long
time) when lying down or with supplementer attached.  Oral anatomy appears
wnl.  Any ideas?

I was tempted to use a nipple shield to make teat smaller and maybe improve
amount of breast tissue he was taking in but I hesitated.  Anyone have any
ideas?  I told the mom have have plenty of moms with flat, inverted nipples
that would kill for a nipple like that, but this mom and baby seem to not be
able to get it together.  Thanks   Lori

Lori Werrell
St. Mary's Hospital Breastfeeding Resource Center
Leonardtown MD

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