Very interesting case I saw today.  Mother of preemie, dob 8/31/95, 2.
10 lbs
released from NICU on 9/27/95.  Mother states he was evaluated once
by an
OT and that she does exercises with him daily.  He has never been
offered
the breast (we really don't know why) and she presents today, not
because
she wants to BF but because she thinks she is losing her milk.

This is a 43 y/o white female who states she was an infertility
patient. She
has recently moved and she has been on a weight loss diet, and
success-
fully lost 18 lbs in 2 months, thank you very much.

Today the infant weight 6.10 oz on M...scale.  Gentle prodding of the
chin to
elicit open wide mouth reveals aversion behavior to any oral stim.  I
asked the
mother to show me the exercises.  She forces her finger (with a nail
about
the length of four of mine-that's long) into his mouth and
demonstrates what
she terms a "gum massage" which she states the OT told her to do to
unglue
his tongue from the roof of his mouth.

I asked if I could offer him his bottle (with a NUK on it) He
would'nt let me in.
I played and talked and sang, and gently asked to come in his mouth,
he opened and let me assess.  I found the palate to be wnl, and the
tongue
retracted way back, occassionally trying to push, then troughing ever
so
slightly.  I asked my assistant to hurry and draw up EBM in a
periodontal
syringe and he sucked rhythmically and really enjoyed the feed to the
joy
of his mom.

She had come in with a cocky sort of attitude.  Somewhat challenging
me,
just what can you do?  She left knowing 1. She should have a
reevaluation
by a OT-i will find one for her..2. She has thrush, that's why her
nipples hurt
and are flaky red and inflammed and 3. DC her exercises, and 4. DC
Dairy
in her diet (this babe was so congested) and 5. How to pump and stop

dieting!

I was challenged.  Never saw a baby with a bite like this before!  I
mean he
really bit down hard-I turned my finger over, gently pushed down on
the
tongue, and when he suck returned to a nice rhythymical suck/swallow,

I gave more EBM.  He got nice and sleepy and was so content not to
struggle
with his bottle.  Mom was impressed at the efficiency and especially
with
his demeanor.  Now I have to find a really good OT in S. Florida-HELP
LACTNET!