...so after a while, we LC's see zebras EVERYWHERE -

I've been seeing the cases that PHNs are having trouble with.  When we have
a new PHN, I try to make lots of home visits with her so she can see what I
do and learn about "normal" .. The trouble is, I usually DON'T see normal -
they call me in for their PROBLEMS!

Well, this new young PHN stopped by my cubicle to ask me how she should
approch this 16 year old mom who has been pumping for a MONTH and thickening
the milk because the baby was born with lots of complications - including
paralysis of the left side of the face and mouth - lower lip hangs down as
well as problems with the right arm and a club foot.  AND the MD she just
saw for the first time told her she should now be able to breastfeed and to
stop thickening the milk!

I of course suggested we meet at the mom's home.

Go in to this very poverty-stricken home - find this very calm mom sleeping
with her baby next to her.  I weigh the baby (excellent weight gain -
exclusively breast milk fed, but bottle fed) and then perform an oral
assessment - tongue - excellent, bilateral movements, cups beautifully,
perfect peristaltic movement, accepted suck assessment eagerly.  Palate
lovely, no abnormalities ... and baby went to the breast with NO problem
(even though he wasn't hungry - had had a bottle 45 minutes ago).  Milk
transferred in 10 minutes 1.5 ounces - mom had such a let-down that baby had
to come off to breathe.  In fact, I did have the nurse put a glove on and
feel the suck - so she would know what NORMAL sucks feel like!

I guess after the last few cases I've had, that have been doozies - I needed
one like this one!

Jeanette Panchula

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