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Date: | Mon, 11 Feb 2008 13:34:59 EST |
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Good Morning,
I am seeking some advice if I may. We presently have a full term baby in
our NICU that is requiring oral gastric feeds. On consult for him are an ENT
as well as genetics. They are thinking that he has tracheomalacia as well as
a possible "syndrome." He has a very difficult time breathing at all times,
not just during feeds. On exam, he has a very small mouth, receding chin and
his tongue is very short and thick. He also has a thick frenulum which I
believe causes the tongue to stay up to the roof of the mouth. The palate is
also somewhat flat. I did put a gloved finger in his mouth to see what his
suck was like, which is uncoordinated and the tongue is not long enough to
extend past the gum line. The tongue also does not curl around the nipple. I
gave mom a nipple shield, placed the baby in the football hold, with him
sitting up as much as possible and then helped her get him in a very deep
asymmetrical latch. Mom is large breasted so I had her use the C hold to make a "sand
which" for the baby. He appeared to be making some good attempts, but them
became fatigued and lost whatever coordination he had and began to push with
the tip of his tongue and bite using his gums. When he came off of the
breast there was some milk in the shield, mom is still at colostrum phase. My
question is this, what more can I do for this baby? He actually does not suck
effectively with the artificial nipple either. I asked for a speech therapy
consult. I have to be honest though, our therapist is not peds or
breastfeeding trained but he is better than nothing.
Any and all advice you can share with me is appreciated.
Thank you so much,
Lori Lindsey , RN IBCLC
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