I just am back at the office from an infant with multiple issues.  Mom is
trying to breastfeed, has a rented pump, the baby is ten days old, she is
getting about an ounce when she pumps.  There are multiple issues with this
family.  Mom is an insulin dependent diabetic who may have insufficient
breast tissue, little change with pregnancy, but today had a quick let down
of some drops when infant cried.
The major issue is the infant, he is very large and very floppy, keeps lower
lip tucked when awake or asleep.  He did not easily cup or finger feed
initially. He tends to suck in such a way as to cause a dimple in his cheek
by his nostrils.  Family is supplementing with formula, started to use the
small premie bottles with the narrow nipple, infant does well with that now.
Using a wider based Avent nipple, it takes him a long time to get started
and he is quite slow with it.  We can get the upper lip flanged out with
work, but in a long home visit, I never got the lower lip out at all.
Mom is going to keep trying, infant is easily frustrated at breast, he will
latch, suck a few times and pull off.  He will do finger sucking for
consolation happily but won't at the breast. She is going to call me with
concerns and I will go back and visit next week.
Any good ideas on how to work with this infant with latch and suck.

Pat Thomas PHN IBCLC
Winona County Community Health
Winona, MN

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