PTP

A mom I am working with has a baby with a very tight anterior lingual frenulum and a tight labia frenulum.  She has gained weight very well but has terrible reflux spitting up ounces at a time.  At one feed she transferred 4.8 ounces in 25 minutes.  She spent most of the feed latching on and off, and clicking, gulping and swallowing a lot of air.  She was very fussy at the breast and needed a pacifier afterward to be calm.  She vomited at least an ounce of her feed.

Early weight gain was a pound a week but her gain has averaged 8.5 ounces a week since return to birthweight so I don't think she is currently gaining overly fast.  Baby is 3 months old and was born 34w 5d at 6lbs 5oz.  She was discharged at 10 days exclusively breastfed and gaining well.

I suggested revising the ties and lowering the amount she was pumping (10 ounces a day) until she wasn't pumping any more.  I also suggested offering one breast a time and only using the second side if baby really wanted it.  I didn't suggest full block feeding yet since the baby is tongue-tied and I was concerned for mom's supply if she block fed.

Mom has not scheduled the revision but she had already scheduled a swallowing study which took place today.

The study shows that baby is aspirating.  Therapist wants baby to be on thickened pumped breastmilk.  Mom is devastated.  She does not feel able to cope with pumping and bottle feeding as well as holding baby upright at all times or baby vomits a lot of the feed.

I know that aspirating is common for tongue-tied babies and mom may still consider revision.  Is it appropriate for mom to continue to feed at the breast and not take the advice of thickening her milk and bottle feeding?  Does thickening breastmilk even have a good evidence base?  Wouldn't that make it more dangerous if baby aspirates or refluxes?  I don't feel educated enough about this subject.  Also, the therapist told mom that baby needs to tuck her chin when feeding, the exact opposite I suggested.  Which is correct?

Laura Spitzfaden, LLLL, IBCLC

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