Isabella,
I think that first and foremost this mom's resistance needs to be addressed and validation of her depression and feelings of being overwhelmed (not to say you aren't doing this, just sharing what I'd do). Having a baby who struggles to eat and then does so ineffectively is exhausting and discouraging for moms. I find moms/parents who are unfamiliar with complimentary health care need lots of information about it first and feedback from perhaps other moms who have used it. Dee Kassing's article on CST (on kellymom.com and lowmilksupply.org) could be helpful and arranging for others who have used perhaps the practitioner she saw or someone else to be willing to speak with her. Getting her pedi on board with evaluation of baby both structurally, maybe a physical therapist (closer to medical model) and for tongue-tie by ENT who will acknowledge and revise a posterior tie would be helpful. Giving mom articles and information about long term possible effects of tongue-tie could possibly help, but back to the beginning, one needs to deal with mom's feelings first, how she feels about continuing, what her goals are, what her support system is, etc.
It also sounds as if just breastfeeding is not getting baby the calories needed for growth, so supplementing first and then offering the breast to finish would shorten feeds, help baby gain wt, and lessen the exhaustion for both mother and baby of prolonged feeding. How does mom feel about using a feeding tube device? It may be overwhelming, too so bottle feed of x amount may be more doable for her. Lots of questions come to mind but this could be a start. Reflux could be result of tongue-tie effects on swallow and feeding so as you likely know, medication for reflux is usually bandaid therapy :(
Barbara Latterner, BSN, RN, IBCLC
Brewster, NY
Permission to post:
I have been seeing now 2 mo girl since a few days after her vag. hospital birth.
She lost alot of weight and by the time I first assessed the
latch/positioning/etc., baby was lethargic and very low weight gain, green poop.
Birth weight was around 8 lbs (I am at home, no records here) and it took her
about a month to regain the weight. Now at 2 mo she is about 9.5 pounds. Baby
has a very ineffective latch, spills milk and can be detached easily. Baby will
only latch to RT side and only in football hold. She throws up alot, and its
hard to say how much. She had distorted/damaged nipples when I first saw her,
but the RT (only side she is feeding off) appears round and healed now. I did
not see typical tongue tie or overly small chin/jaw, but to be sure I asked her
to go to pediatrician/CST / pedi ent. She went once to CST and felt very
uncomfortable and left before assessment. Never went to Pedi Ent. She has been
following up with Pedi who (as baby is now gaining -- albeit slowly) just tells
her to "keep up the good work".
I have a very strong gut feeling that the baby has either one of the difficult
tongue ties or some anomaly of the palate or mouth/jaw physiology not allowing
her to stay latched effectively. Mother is very resistant to seeking specialist
help. Most recently the doctor diagnosed baby with reflux. She filled the
prescription for ranitidine, but mom says it really doesn't help with the
spitting up.
I have asked her to supplement with her own milk at the breast (w #5 french)
and she says that if she gives baby too much milk at a feeding she throws it
"all" up. So she just sticks with feeding about every hour and a half on one
side. She is exhausted, possibly depressed, and will need to go back to work in
3 weeks.
ANy ideas?
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