I have another difficult case and am struggling with what else to work on.
A 37 weeker, now almost 2 weeks old and well below birth weight.  She didn't
latch well from the beginning, small mouth, slightly tight tongue, not tied,
but tight, doesn't come far over the lower lip. I saw her briefly in the
hospital, don't work there.  Baby started to get jaundiced, was under
lights, and the hospital nurses started her fingerfeeding with an S&S and a
nipple shield.
Now I am back from the great WALC workshop and back visiting.  Yesterday
infant was 8 ounces under birth weight, transferred about a half an ounce
with the nipple shield.  She nurses briefly on the nipple shield, swallows
what is in the tip and waits.  Mom is basically hand expressing into the
shield and baby swallows.  She does well with finger feeding, but family is
frustrated.  So I had brought a bottle, the evenflo ultra nipple and we
tried that.  This infant can't latch well on this either, was quite confused
and tried to work the tip, milk rolling out of her mouth. With some work,
mom and baby finally got this to work a bit well, but still loose at the
corner of her mouth.  Palate seems normal, tongue humps a bit, think this
may be secondary to finger feeding since I hadn't noted this when I saw her
first in the hospital.
Family has been playing with infant to open mouth and stick out tongue with
limited success, partially because of their huge extended family who is
there almost every moment the infant is awake and want to hold her.
I sent mom back to the pump since her supply initially huge has dropped back
to normal, can always pump 2 ounces, used to get 4.
I am encouraged much skin to skin and cobathing, all hard with the baby
party going on.  Mom really wants this to work but is getting exhausted and
discouraged.  Anyone have any other thoughts about this. Thanks.

Pat Thomas PHN IBCLC
Winona County Community Health Department
Winona, MN 55987

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