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Subject:
From:
Claire Pipes <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 26 Jul 2006 09:02:17 -0500
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Please consider refering to a reputable Chiropractor for a possible cranial sacrial adjustment. 


Date:    Wed, 26 Jul 2006 01:58:42 EDT
From:    Pamela Mazzella Di Bosco <[log in to unmask]>
Subject: weak lips and cheeks affecting latch?

Looking for input about helping a baby latch who has been unwilling/unable  
since birth to take the breast.  When I first saw the couple, baby was only  4 
days old and absolutely refused to even attempt to breastfeed.  This is  after 
two days of non stop skin to skin, co sleeping included.  Mom is an  
experienced breastfeeding mother of 4 previous children who took to breast  
immediately at birth, nursed for years, etc.  This baby would not latch in  the hospital 
after normal vaginal delivery.  Mom began pumping and feeding  the baby with 
a spoon and continued to do so for days.  Still no latching  baby.  Finally, 
mom frustrated and baby frustrated, mom used a bottle with  paced feeding, slow 
flow nipple, etc. 

This baby was so tense and tight  fisted and just screamed when placed even 
in the proximity of the breast.   Even on the bottle the baby would not really 
suck, more like a chewing chompy  motion.  Tongue would not relax, but no 
tongue tie, and when not feeding  baby will put the tongue way out.  Mom decides 
to pump, bottle feed for a  bit and wait and continue to try to offer the 
breast while protecting milk  supply and feeding her baby.  Two weeks, and the baby 
is just now relaxing  in her arms when in front of the breast, fists no 
longer tight, arms and body no  longer so tense and stiff.  They come to see me 
again, and honestly it was  like a new baby all calm and relaxed.  Still, not 
latching.  I have  seen a lot of babies over the years, but only a few who do not 
make the  connection between drawing in a nipple to suck even on a bottle.  
This baby  used the tongue to try to force the bottle out also.  
 
Okay, so what to do?  Outside my capablity.  I am totally aware  something is 
wrong, not a therapist for newborn sucking disorders, so cannot  figure out 
what is up with this baby.  Ask mom to take the baby to the  pediatrician to 
rule out any reason to protect airway.  (Mom says when baby  spits up, 
occasionally milk does come through the nose quite a bit, so at least  she should rule 
out any possibility of a hidden cleft---not to mention I am  looking for a 
good reason for this baby to not want to relax and eat.)   Next, to take the baby 
to a specialist (good luck in finding one that  understands breastfeeding).  

Pediatrician says no reason for the  baby to be protecting air way.  Okay, 
one possibility not correct.  On  to the speech therapist specializing in 
babies.  Her conclusion?  Baby  can suck, swallow and breathe just fine (of course 
only seen at the bottle,  since she did not ask to see how the baby reacted to 
the breast, only wanted to  see how the baby bottle fed) and said the tongue 
was within range of normal, but  the lips and cheek in relation to the tongue 
were weak. Also, stated 'no  sign of sensitivity disorder'. was wrtitten (which 
is at least one thing we can  rule out?)  Her diagnosis was that there is 
nothing wrong, and the  baby just wants the bottle.  Told the mom to support the 
cheeks during  feedings to help equalize the strength of the cheeks and the 
tongue.  Those  were the exact words she wrote for the mom, and basically told 
her that her baby  just doesn't want to suck except for reward, so the breast 
does not offer  reward.  (Not making sense to me as the mom is a fountain of 
milk and  easily expresses more than a full supply for this baby and can easily 
hand  express milk into the baby's mouth, but baby still will not take the  
breast.)  

Quitting is not happening.  This is a mom who  breastfeeds in years not 
months and she is determined to keep working until her  baby does breastfeed.  But, 
since my brain always goes back to "A baby who  cannot breastfeed is a baby 
with something wrong, because breastfeeding is the  biological normal behavior 
to eat and survive", what is missing here?  I  have a plan in mind for mom to 
try next since the therapist says there is  nothing wrong and baby should be 
able to breastfeed, but am looking for other  ideas too.  And wondering if the 
tongue and cheeks being week would make  the baby unwilling, unable to latch 
to a breast as opposed to tolerating the  bottle (which in my uneducated 
opinion the baby also does not appear to use the  way a baby typically sucks on a 
bottle.)  I do not think the bottle is the  culprit here because it was the last 
thing used to make feedings easier and I  have worked with far too many 
babies who have had weeks of bottles go to breast  easily once the bottle feeding 
method was changed and the option of  breastfeeding was offered properly.  This 
baby does not suck the way a  breastfeeding baby should, and even though the 
therapist says the baby is  'within range of normal' for behavior, maybe that 
range of normal is not based  on normal at all, but is based on the ability to 
bottlefeed?  I may not  know what is wrong, but I am fairly certain when 
something is not right.
 
Thanks so much,
Pam MazzelalDiBosco, IBCLC, RLC
Florida, USA

 

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