Dear All,
FRUSTRATION!

Once again I am turning to the greater knowledge of the group.
I saw a baby today who was 3.320 at birth, and went down to about 2.570 at about at lowest point.  Did not regain birthweight until 3 weeks.  One doctor checked baby at that point and even though mother had a "not good feeling" about the BF he told her everything was fine.
Baby is now 4.200 and 11 weeks old.  She is always fussy.  This is mother's 4th child, and the oldest in 4 yrs old.  She totally has her hands full.
Basically, throughout the past 10 weeks, she has seen 2 pediatricians- both pride themselves on being very pro-breastfeeding (SCREAM!  I feel like saying ignorant and irresponsible) and told her this slow weight gain is fine, nothing to worry about, just keep BF.  Baby totally has the FTT look.
She makes a very loud clicking sound at breast.  This is one of the first times I have come across this without a high or bubble palate.  The palate is totally flat and low (not abnormaly so...).  She clicks on digital suck exam with finger, and also bottle.  The only thing I observed was with a bottle, sometimes if I would apply pressure on her cheeks, the clicking was a bit less loud and seemed to then come from more of the front, whereas normally the click sounds almost from the back of the mouth.  I tried to feel for an undiagnosed cleft of some kind, their flashlight was very weak, and I could not see anything, although that is probably a very long shot, even though I did have that once- and nobody in hospital had noticed it!
On test weigh, I was shocked, baby managed to eat about 80 cc in 15-20 minutes.  Mom said it was possible she was more full, and not all feeds were as good.  I was surprised, because with the amount of clicking I expected more like 40cc.
Mom had major over supply with first 2 kids, so she will have no problem pumping to supplement. which is of course what I recommended.
What else would cause clicking- would an ENT be able to evaluate something here?  I have a feeling the baby is overcompensating for something here, I feel I am stepping into the show at act 2- I have no idea what went on that first few weeks, but clearly not proper BF.
I am not really sure how to proceed- Besides getting the baby to start gaining more weight.
In terms of the latch, we of course had alot to work on, but even with correction and an achieved deep latch, the clicking continued just the same.
Where From here?  Any ideas?
Please mail privately as well as to the list.
As Always,
Thanks!
Jessica Billowitz, IBCLC
Israel

P.S.  The depressing part of this case is how failed by the system this mother was.  3 doctors saw baby and not one had the good sense to think maybe things with the BF were not going as they should and see an LC?  A 90 gram weight gain a week and no problem, don't even evaluate?  Losing that much weight after birth and don't bother to investigate?
These poor mothers and babies.  2/3 MD's were American-  An Israeli doctor would have had this baby on formula before the mother blinked her eye...but I am so frustrated at this point I don't know which is worse....
I had a lousy day...can you tell?


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