Hi Celine
I have heard this clicking sound several times and it seems with the baby
you describe it is related to tongue tie, which correlates with my
experience. I don't think you missed anything. I definitely agree mother
should be regularly expressing, feeding to baby by alternate route (finger
feeding was what they used in your case), and doing the STS as much as
possible. It seems the baby and mom had a difficult birth with an induction
and c/s.  Many babies improve over the next 3 days as they recover, in my
experience, however they should be receiving mom's expressed milk in the
meantime. If baby needed phototherapy right away, at 24 hrs old, this is
pathologic jaundice and is likely a blood type issue, however poor feeding,
infrequent feeding, and bruising will certainly contribute to the bilirubin
load.

The pediatricians in our area are definitely anti-clipping, although once in
awhile one will get clipped. That is a hard one to work around. A very
assymetrical latch with the head extended often works well and I have seen
many babies improve over several days of practice. However, most mothers
will have to continue to express and provide pumped milk feeds in addition
to the breastfeeding for quite some time if not for the duration of the
lactation. If mother's pain is pretty high, this can often make the case for
clipping.
This week I am having quite a number of tongue-tied infants. This seems to
come in clusters, which I hate, because I think the doctors think I'm
dreaming it up for every baby. One tongue-tied baby came to followup
appointment today. He was doing better, only transferred 24 ml at breast (10
days old) but prior to that was removing virtually no milk. Baby does a
little better with a shield, but mom does not like using it. Mother has
chosen to bottle feed ebm, and does not want the tongue released, and on the
bottle baby makes a loud smacking/suction noise with each suck.
Laurie Wheeler RN MN IBCLC
MISSISSIPPI USA

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