Re: << Yesterday I saw a mom and her preemie twins. The babies were born at 34 week and are now three weeks old and both still under 5lb. They seem to be nursing well and gaining slowly. Mom has sore nipples, and says that they babies nurse almost non-stop. I checked positioning and we worked on latch a bit. The funny thing is, one of the babies has a very tight frenulum. The other's oral anatomy is just fine. It's the one that does NOT have the tight frenulum that hurts mom when he nurses. I think that we got that pretty well worked out by correcting positioning.

What I am wondering about is this; could having a tight frenulum, even with
good nursing, no nipple trauma or pain, lead to the baby not having his
sucking needs satisfied? This baby needs to suck almost all the time. He
nurses till he falls asleep. Sleeps for about 5 to 10 minutes and wants to
nurse again. When he is not nursing he is rooting. He has plenty of wet
and poopy diapers. Any thoughts on this? >>


I would think that their gestational age could have as much or more to do with these babies' ability to suck effectively as a frenulum issue. Most 34 weekers cannot sustain suckling long enough to effectively remove milk in adequate amounts for good weight gain. At 3 weeks, these babies are still only 37 weekers and babies at this gestational age are often still having problems sustaining suck. I don't think it's about them meeting sucking needs; sounds as if it's all about getting enough food. They've been "asked" to do a job their CNS and mouths usually wouldn't be ready to do yet. I'm surprised that they've done as well as they have but am not surprised they've been constantly BF, which is a red flag for ineffective BF -- as are mother's sore nipples.

Personally, I wonder if it's in the babies' best physical interests or the mother's emotional interest to be BF as much as described. Within an individual feeding, sucking becomes less organized/effective over time, and the most effective sucking is done within the first 10 minutes or so. If looooooong feedings get less organized, what are they accomplishing vs. what kind of energy expenditure is going into each baby being able to get enough food at this point? 

Karen G

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