Saw a mom/baby today at request of ped.  Baby is 6 days old and has not fed
well since birth.  8 lb. 12 oz. at birth.  8 lb. 2 oz. on discharge and today
at peds visit.
Had been supplementing with ABM.  However, mom's milk supply is excellent.
Reports that baby had trouble maintaining latch from beginning.  Vaginal
birth, following early pitocin, slowed labor and vaccuum extraction.  4th
degree tear.
Parents report cup feeding was a disaster.  Finger feeding with SNS was
better, but slow.  Started Avent bottle yesterday and that is slow also.  Got
baby to latch with a nipple shield with SNS tube inside, but there was a
whole lot of "slurping" going on and very little swallowing.  Took a long
time to get 1/2 oz. from SNS.  I observed finger feeding--very slow and
bottle feeding--not much suction unless the bottle (Avent) was placed against
the upper lip.  Even then, it was slow, taking a long time to transfer 2 oz.
Baby has a tight lower labial frenulum.  I will call the ped tomorrow a.m.
He's very breastfeeding "supportive", but hesitates to get consults for
tongue ties, so I don't know how he will react to this.  I am suggesting ENT
consult.  Is there something I'm missing that can cause "slurping"?  Since
this baby is taking so long to feed, what other suggestions would you have to
get the milk into him?  Would a Haberman be worth a try?  Could the tight
labial frenulum be the sole cause of his feeding problem?  BTW, on pulling
the lower lip down, the tongue is visible, but mostly chewing, with what
looks like an occasional good suck.   Now, I'm taking my first break today,
for a peak at the Olympics.

Alice Ernest IBCLC
Simpsonville, SC

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