Hello--I have a case making me scratch my head-- thought everyone else will
have an idea-- PWP-  New case to me of a now 4 week old BG, born on due
date, gestation age assessment also states 40 weeks, BW 7 lbs 4oz.  Per
parent history baby has never able to latch at breast, kept longer in
hospital due to this (3 days) for these feeding difficulties, then DC with a
bottle.  Baby born with an epidural, but other wise non-eventful labor and
delivery. Oral assessment with a +gag, unable to engage any
coordinated/purposeful tongue action, mostly tongue lays at bottom of mouth,
touching lips gets positive tracking and opening.  Tongue is not tied, has a
groove, is not short or long--it looks normal but simply does not move, but
with random movements (honestly in 12 years have never seen anything like
it)!! Palate also normal, airways open.   Parents have been feeding EBM
using a bottle with very fast rate-- on initial contact attempted cup
feeding with a lot of crying and  stress seen on baby. Parents also hated
the cup-- attempted fingerfeeding with no results, baby will not engage to
suck!!  When I place 5 cc in mouth via finger tube, baby able to swallow it
without problem. Baby observed with paced bottle feeding with both the fast
and slow flow bottle.  Baby uses jaws only to chew bottle then able to do a
swallow and breath-- did this all with a very slow flow bottle much easier
then with the fast flow.   I referred baby back to ped for oral eval,
encouraged no pacifer (which baby was offered by parents, but never took)
and adult finger offered for sucking at least 4 times per day, as tolerated
by baby.  Ped states if baby can bottle feed then there is no issue!!  No
further eval needed.  We have no CST in area and even speech/oral therapist
rare and the two we have do not want to eval a baby---I saw the baby today
after  one week of finger sucking at home and paced slow flow bottle use
with no change to oral assessment-- What else can/should I be doing?

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