Many thanks Jean for what I think is much more than $.02 worth!

I just spoke to mom last evening who was tearful and felt she could not go
on as she has been dreading every feed.  She gave me more info over the
phone also which may help to unravel what is going on here.
 I'll try to take you through this one step at a time.

I will have the parents or mother's doctor look again to check for a cleft.


Both these parents are physicians and I did ask them if baby's mouth had
been well looked at after explaning that the clicking can be a sign of cleft


in small palate.  But I didn't do a thorough check myself--perhaps my first
mistake! Question:  Would the mother be able to feel baby "get it" (tug) and


then lose it as she does if there was a small cleft?   May I ask how you do
such a check of the soft palate?.  I've found I have to wait for a big yawn.



I don't think I'm an expert at digital suck exams actually and feel this is
one
of the more challenging cases I've come up against which is why I've brought


this to LACTNET.  I'm not certain the hard palate is short but it was an
impression I had.  I am quite certain though that the baby's suck is not
quite right. I'm pretty certain the posterior part of the tongue loses
contact with my nail at one
point during the suck.  Mother is certain baby has never been able to latch
well and pointed out to me how easily he comes off. She does however state
that she can feel it when he does "get it" as above and then can feel when
he's "lost it" when he does some mild clamping. Would he be able to do this
if he had a small cleft?

Re: the oversupply-like symptoms.
I too, after hearing mother's descriptions over the phone, did go to the
home visit wondering if this wasn't simply an oversupply problem.  At the
feeding I observed the baby did "just cope" i.e. there was no choking,
coughing or spluttering though he makes all that noise and does come off and

on.  What intrigues me though is mother told me on the phone last
night (after the home visit) that he is no longer able to latch to left side

unless the breast is very full.  She thinks her supply has come down; feels
only one or two letdowns on that side whereas she always feels several on
the right and baby feeds "well" i.e. in his usual noisy way, on the right
side.  This right vs. left thing was not a problem until after her
left-sided mastitis and thrush-like symptoms.  It would seem she thinks he
only gets enough when breasts are very full.  This would "fit" if this baby
does indeed have a cleft of soft palate.  She was asking me about one-sided
feeding and was considering pumping left and feeding only right.  (I agree
this is going off in all directions and I can't seem to get a handle on
it!!!)

Now re: thrush.

When I first spoke to this mother over the phone after consult recieved by
her physician, I called her up right away as I was leaving town that
thursday and would not be able to see her as it turns out until Tuesday (I
was going to see  K. Dettwyler and Jack et al. speak in Toronto).  From info

she gave (deep breast pain, burning, just over antibx, clicking worse than
usual) thought there was probably thrush though I new there was more to the
problem but that would have to wait until I could see her.  I suggested
Gentian first, as I always do, because it often does help at least some,
especially the baby(mom had emphazised how baby was coming on and off breast

all the time and this was worse since antibx).  Jack has also found that it
does help the deep breast symptoms in some mothers.  As it turns out mother
(remember she is a physician) decided she didn't like the idea of using
Gentian and she was concerned about staining.  She saw the referring
physician, who later told me he told her he supported use of Gentian but
gave her what she wanted which was a one time dose of Flucanozole for her
(as for vaginal yeast) and Nystatin drops for baby.  So when I called back
after that conference in Toronto she had no changes at all in symptoms.  I
did convince her at the home visit to try Gentian.  As of last night (just 2

days of tx) she felt her deep aching was gone but burning and nipple pain
still there.  When I spoke about the flucanozole tx (probably 2 week
course--I had left her with Jack's handouts on Gentian and Flucanozole)
she told me she wouldn't consider it as she feels she has taken too many
drugs already since having this baby (she had C/S).  I don't think I'll be
able to convince her that these small amounts of drugs in breast milk for
relatively short time are far better than long term use of formula.  She
wasn't receptive last night to any more suggestions and asked for info on
formula feeding.

I feel I've failed this mom and yet I know I just haven't had the time to
work enough with her.
Thanks so much Jean for that VERY informative post. I learned much and know
there is still so much more to learn!

Genevieve Courant MSc, RN, IBCLC
Sudbury, Canada




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Name: Genevieve Courant
E-mail: Genevieve Courant <[log in to unmask]>
Date: 03/05/99
Time: 06:28:38

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