Dear Lactnetters,

I'm currently helping a 1st time mother whose baby isn't latching well or
transferring milk.  I first saw this baby at the beginning of his 4th 24
hours.  He was at just about 10% weight loss but mother's milk was in that
day.  Mother's nipples were scabbed with pinch lines.  Baby transferred
approx 1/2 ounce from both breasts.  Took another 1/2 ounce that we pumped
right then by supply line at breast but not happy at breast at all.  He
would fall asleep after a few sucks, even with compression.  He never seemed
to get a good jaw excursion.  It looked more like flutter sucking.  Even
with the supply line.  Showed parents how to finger feed and even then he
only lightly compressed finger.  He needed to have gravity flow, he never
sucked well enough to get milk from the supply line otherwise.  No curling
of tongue around finger.  Baby was pretty yellow so encouraged parents to
have that checked the next morning.  Baby had a visible frenulum that
*seemed* to me to be restricting tongue movement, but it wasn't dramatic or
at the tip of the tongue.  I'd say about a cm back.
So they left that afternoon with a good rental pump and instructions to feed
the baby & protect the milk supply and keep working on the latch.  Of
course, the instructions were much more detailed than that, but that' s the
main thrust.  I also encouraged them to talk to the doc about the tongue and
my observations.  Which they did yesterday.  The doctor at the peds clinic
said that it's ok, the tongue will stretch and that shouldn't be any problem
with breastfeeding.  So mother is asking me for names of other doctors.  At
the time she said that her husband felt that the tongue was probably
affecting the feeding and agreed with her that it needed to be taken care
of.

Today I saw them both (beginning of 6th 24hr) and we used an starter SNS at
the breast with a shield (after trying briefly without a shield).  That
worked fine to get him fed *at* the breast, but he didn't transfer any
*from* the breast. He has gained over 6 oz in 2 days.  No bottles, just
finger feeding.  Mother states that now her husband wants her to just pump
and feed him with a bottle until the tongue stretches.  Doesn't like the
idea of the tongue being clipped.  The little one *is* circumcised, though.

I figure the next step is to try and get the baby evaluated by OT for
sucking eval?  I'm not sure how successful I'll be at that though, since the
family is military and the ped already doesn't think there is a problem.  I
gave the parents copies of the Pediatric article and several JHL articles on
tongue tie.

So where do I go from here?  Refer them to OT and be done with it?  How can
I help if the tongue won't move?  I'm teaching asymmetrical latch and good
positioning already.  Mother is pretty good at it, but no go with little
one.  Without the shield, he wouldn't stay latched to use the supply line.
With a shield, at least he can get the EBM at the breast, even if he still
isn't transferring any milk.  If they don't want to get the tongue clipped
and the doc won't refer them to OT, do I just tell them I've done as much as
I can?  Is there anything else I should be doing?

Thanks in advance for any ideas, suggestions, comments.

Regards,

Cindi Swisher, RN, IBCLC
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