Catherine,
A few days ago, you asked me whether I'd done pre/post feeding weights.  Yes,
mom even rented the BabyWeigh Scale to conduct these weights.

In a previous post, I'd mentioned more on the history of this mom.  She never
had milk flow from her left breast despite all of the usual methods for
increasing milk flow.  All we can figure is scar tissue from nipple piercing.  Or,
possibly insufficient glandular tissue.

You stated in your prior post:  "(laryngomalacia, tongue tie) and that caused
slightly inefficient feeding and led to a gradual reduction in milk supply."
I'm struggling to understand where these ideas have relevance to my post.  We
realize that tongue tie is an issue when it causes nipple pain, right?  And
as a result of the baby's inability to sustain a deep latch, a poor milk supply
may take place as a result of incomplete emptying of the breast.  But, this
is a 6 month old baby who as I stated in my prior post has been effectively
breastfeeding since my consult when the baby was approx. 1 month old. Now, I
think tongue tie babies that aren't clipped usually achieve breastfeeding if mom's
been willing to maintain her milk supply with pumping as a result of simply
getting bigger.  So, without the mention of sore nipples in this case history,
I don't understand where your thoughts on tongue tie came from.

Secondly, I also don't understand your thinking regarding this baby
exhibiting any hints of symptoms related to laryngomalacia.  As a prior manager of a
unit specifically for infants who were ventilator-dependent with tracheostomies
related to conditions such as laryngotracheomalacia, I feel I have an
excellent understanding of these respiratory conditions.  But, despite my clinical
background, I wanted to seek out a reference to use in my conversation to verify
my concerns.

Thus, according to the source "Neonatology: Pathophysiology and Management of
the Newborn" by Gordon Avery, M.D. 3rd edition, p. 948 (this is not the
latest edition, but the definition hasn't changed):
"the combination of a narrow tracheal diameter & lack of firm cartilaginous
support permits compromise of the lumen with each inspiration.  Momentary
collapse of the larynx and cervical trachea results in a characteristic stridor.
This is accentuated when respiratory efforts are most vigorous, such as when
the infant is crying.  Although alarming, the stridor associated with
laryngotracheomalacia is usually self-limiting, requiring no specific treatment.  It
generally resolves by 6 to 12 mos. of age as the cross-sectional diameter of the
tracheal lumen increases and the supporting cartilage matures."

So, again in discussing this 6 mo. old, I don't understand where your
thoughts regarding laryngomalacia stem from.  An infant without a history of
respiratory distress doesn't suddenly develop these conditions around 6 months of age.
 The baby with tongue tie or laryngomalacia usually outgrows these conditions
as he or she gets older and bigger.  My original post presented a case of a
baby growing fine and getting enough to eat up to 6 months of age, and now
exhibiting signs of inadequate intake, necessitating other means of calorie
intake.

I look forward to hearing your response to my concerns.

Carol Chamblin, RN, MS, IBCLC
Breast 'N Baby Lactation Services, Inc.
St. Charles, IL







             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html