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Subject:
From:
Kermaline J Cotterman <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 4 Mar 1999 11:36:50 EST
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Genevieve,

You wrote:

<This baby has been making "clicking' sounds at breast since birth.
After a bout with mastitis 2 weeks ago and a course of antibx, the
clicking has become worse according to mom and she has experienced
typical signs of thrush (achy breasts, burning during and after feeds;
nipples feel like they've been "grated like cheese"). This baby is
thriving (bwt=8'1", 11'2" at 5 weeks of age). Mother has great milk
supply. Baby has never been supplemented>

<This baby goes on to breast without opening very wide; could be
described as a "slurping latch-on".  Mother's let-down is strong after
just a few clicky sucks and baby is just able to cope with the volume.
The noise he makes is more than a simple click and sounds more wooshy, as
if he's also getting a good amount of air.  Feeds go on for about 40
minutes or more, offering both breasts.  His latch would seem weak, he is
easily taken off the breast. >

<palate seems normal, perhaps a tad short>

These are some things your post brought to my mind.It seems as if you are
very observant, and quite expert at digital assessment of the baby's
mouth. Have you looked closely with good light to make sure there is not
a small cleft in the soft palate?

There are lots of threads here, and I hate to see you "jump on your white
LC horse and ride off in all four directions at once." Why not
investigate the simplest factors more or less one at a time so you know
what it was that did or didn't bring relief?

I would like to see you investigate some simpler things before jumping to
the conclusion it's the fault of the baby's suck. Suck training seems so
invasive to me, especially when a baby is thriving and getting plentiful
milk.

Actually, it makes me wonder whether the baby has developed some aversive
suckling such as slurping latch and weak latch just for sheer survival.
Could this clicking and whooshing be part of the baby's valiant efforts
to coordinate breathing, suckling and swallowing without choking from a
strong downhill MER and the baby's dependent nasopharynx  being flooded
with a copious supply?

I wonder if the baby's clicking noises might just be due to the "tad too
short palate", which puts the flexible area closer to the front than you
are used to seeing (and listening) to it in other babies. This would tend
to make it gag more easily also since it puts some areas of the gag
reflex area closer to the front of the mouth. It might also require more
effort to coordinate suck and swallow and breathing without choking.

A short palate would also be a protective factor for the mother's nipple
and perhaps a reason it isn't incredibly damaged, as a shallow latch with
a stronger suck might otherwise be trapping it between the hard palate
and tongue..

I suggest an observational experiment:  #1) triggering the MER by hand
2-3 minutes before attempting to latch so the milk is right ready and
waiting with no "Niagra Falls" thundering down, and #2, positioning the
baby elevated somewhat above the nipple so that gravity is nt onlyworking
against rather than with the subsequent MERs,  but facilitating free
breathing since the nasal passages are suspended above the milk flow
rather than under it.

It would be worth a careful observation of a whole feeding to see if this
makes any possible difference, because it sounds suspiciously as if this
mother may have a somewhat overabundant milk supply, characterized by
very forceful MER's. You mentioned "a great milk supply" but didn't
mention anything about whether or not she has any leaking, and if so,
when - during, or after, or between feedings..

Since I became aware of the existence of the OMS syndrome from Anna
Utter's work, I have begun explaining and encouraging moms to get the 1st
breast as "empty" as possible, switching positions on just the one breast
during a feeding, not only to salvage the hind milk, but also to tap a
different set of milk reservoirs and change the location of any skin
stress on the nipple.

By watching the baby to see if he gets satisfied and slips off the breast
at his usual 30-40 minutes or less, it would let you  know if the baby
spontaneously insists on having the second side, or is this just how we
have "trained"  moms in the last 40 years?

Sometimes, in a mom with larger storage capacity (e.g. C,D,E and beyond)
try having her doing 2 (or more) feedings in a row on one breast and
reserving the other side for use for the next feeding (or two or more),
with the option to choose to use the second side if baby truly wants it.

In some moms this has balanced the milk supply even better and thereby
reduced the usual force of the MER to a gentler level. It's also to stem
any leaking with momentary pressure against the nipple to limit the
amount of milk leaving the breast to just what baby takes.

Overfullness could have contributed to the mastitis, and overfullness of
ducts could conceivably cause internal breast pain from elevated pressure
in the ducts. It might be good to see if this would change if the milk
supply and MER's could be reduced without interfering with baby's growth.
Perhaps this would cause the baby to demand a little oftener than 7 times
a day, however. Would mom accept this trade-off?

If the pain went away, maybe that would rule out internal yeast. If not,
if the internal pain is truly due to yeast, I can understand how GV would
avoid the hassle of seeking an RX for baby, but I don't understand how GV
externally could help the inside the breast.

Thanks for letting me  put in my $.02 worth. Good luck.

K. Jean Cotterman RNC, IBCLC
Dayton, Ohio


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