Before I go no-mail and head off into the sunset on holiday, I wanted to bring you all up to date on the continuing saga of my client, a 4 1/2 month old with complex eating, sensory integration, developmental and maybe neurological or genetic problems. I am happy to report some progress. About two weeks ago, we introduced new oral-motor exercises using a small vibrator, and his lip and facial tone has improved somewhat. Baby seems to actually enjoy the input (he smiled!), and mom is delighted. By adjusting the feeding schedule to 4 hourly (and not focusing so much on his painfully slow weight gain), we find that he is taking about 100 ml per feed, in about 30 minutes, a marked improvement. He still is not exhibiting age-appropriate suck and swallow behavior, but he is managing the artificial teat better. He gained 100 grams last week. Thyroid function tests are normal. Urinalysis normal, no signs of infection. We have secured a referral for the baby for a comprehensive OT, PT, SLP, and developmental assessments, which will happen in the next few weeks. We are still waiting for the results of the chromosome testing. Family has been referred from neonatologist to a pediatrician for ongoing care. In addition to ruling out genetic abnormalities, baby will be screened by the above experts for developmental delays, sensory integration disorder, and autism spectrum disorder. Depending on his progress and diagnosis, we have also lined up an infant psychiatrist to evaluate him if necessary. A swallowing study, reevaluation for reflux, and lower GI tests are also being considered. Treatment by the osteopath continues, and he notes good progress in several areas. Unfortunately, the palate is not one of them, but he reports that minor progress is occurring. Baby is still quite defensive of the oral cavity, and will only take a finger to the depth of a fingernail. Mom remains hopeful that several more treatments will help. He still won't even consider the breast, but mom is pumping and resigned to continuing that for the near future. Mom has requested a nutritional analysis and creamatocrit be done of her milk. I'm working on finding someone in Sydney or Melbourne who can do that. (Oz Lactnetters, if you know someone, don't hesitate to speak up please!) Obviously, this is the beginning of a very long road for this family, and other than continuing to support the mom, I feel that there's not much else I can do in terms of feeding. But I feel good about being able to round up this interdisciplinary team and get them talking to each other. Many thanks to all of you who offered suggestions and thoughts along the way. Barbara Ash, IBCLC Canberra, Australia *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html