Looking for more info.  This week I had my first clear cut breastfeeding 'problem' with high palate.  With permission to post:  Mother of 4 month old, healthy baby girl requested a pump from our WIC clinic.  She had had a Lactina via medical coupon but no longer qualified.

Baby had never done well at breast.  Mom always needed to pump and feed via bottle.  She had been seen by one of best breastfeeding clinics in our area multiple times and had no idea what was happening.  Over the phone I sure couldn't tell anything.  Since returning her original Lactina and using a friend's pump, her milk supply was steadily dropping.  Baby still went to breast but didn't seem happy there.

During the assessment, this little gal latch happily but never relaxed into feeding.  She wiggled and bumped her head up and down and came off relatively quickly.  She was clicking and no matter what we tried it did not abate.  She did slightly better at the other breast as the nipple on that side was more stretchy but still did not appear to be an adequate transfer of milk and no signs of satiety in baby.

After trying everything in the book--I asked if I could feel the baby's suck with my finger...something I don't usually do.  Mom was willing and immediately I found my finger pointing up toward the top of the baby's head!  I had never felt such a high palate--seen the pics but never actually felt one.

The good news was that baby's tongue was quite long and by now quite muscular (could the tongue develop muscle from working so hard to compress the nipple?)  And Mom did not have sore nipples.

After taking a surprised breath, I asked the Mom if any of the multiple LC's she had seen had commented on a high palate.  She said no, but she has an exceptionally high palate herself!  I began to explain why I thought her daughter was working so hard to breastfeed and why she couldn't get enough milk transfer all on her own.  Mom started crying (of course, she had been blaming herself!).  Then she grabbed her toddler who was happily playing on the floor and put her finger in his mouth--lo and behold, another high palate!  She said now she knew why she had 'failed' (her words) at nursing him.

Her HCP had suggested fenugreek but not a high enough dose.  I gave her the recommendations to take to her HCP and issued her a Lactina.  I spent a bit of time letting her know what a great job she was doing and how lucky her baby was that she was willing to do all this for her.  I also remember this being discussed here but I couldn't locate in the archives.

What is the long term prognosis on this?  Will baby ever be able to transfer enough milk (baby is 4 mo. now) and how long may mom need to continue pumping?  When solids are started I am concerned that baby can't maintain the milk supply.  Mom wants to nurse for at least 18 months.  Are there other techniques that might help?

BTW-as Mom left my office she said she was going to call her mother right away because her mother had been so sad that she had 'failed' at breastfeeding her 25 years ago!  Now she knew why! (not to mention her mom was probably blaming herself for passing on the inability to breastfeed to her daughter!)

Thanks for your help!

Michele
--
Michele L. Crockett, IBCLC, PCPA 
Breastfeeding Promotion Consultant 
Washington DOH/WIC Nutrition Program 
Breastfeeding is a health decision, not a lifestyle choice! 

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