I have permission to post. I met with a mother of a 4mo female yesterday who called me for c/o baby taking in too much air and having clicking noises. I had her come in to observe a feed but as luck would have it, there was no clicking to be heard with that feed. Mother originally had sore nipples after delivery and an oversupply which she has managed well. She felt that she had resolved the oversupply. What she has noticed though is that as the oversupply resolved, the clicking started.She does not hear the clicking at times when she is the most full, at night and through the early part of the day. She notes it the most when baby girl is feeding in the afternoon and evening. 
    Baby girl feeds every 3 hours and usually for 5-7 minutes each breast. The clicking is heard before the MER and toward the end of the feed, just before baby detaches and at thosefeeds when the supply is lowest. At the visit with me, baby stayed on the breast for less than 5 minuutes and would not return to either breast without cying and arching away. I attempted a digital exam but baby girl did not care for that too much. I felt that the palate was high and somewhat arched. Baby did not extend her tongue past her gumline when I played with her mouth and tongue and mom could not recall ever seeing her sticking her tongue out. Baby girl's birth weight was 7lbs 5oz and for me was 13lbs 8oz (6140gm). Unfortunately I was not able to do a pre and post feed weight as I did not have the scale available at the start of our visit. ( I share the scale with L&D and there were a few births happening). Mom remembered the last weight at the peds at 3 month checkup being around 5000 gr. The baby is currently being treated for acid reflux with Prevacid and mom gives the baby gas drops. She stated that she has seen a decrease in fussiness but the girl coninues to fuss after every feed. Mom has also been using a probiotic for the baby which she gives to her by putting drops on her nipples before she brings baby girl to breast. 
    I told her that I could not rule out the possibility of a posterior tongue tie. Usually when I hear a mom c/o clicking and "taking in air with the feed" I think oversupply and strong MER but this baby actually handlled that well per mom. The clicking and all comes with the slower flow. I have searched the archives. The c/o clicking ususally came with MER or oversupply. I also read about a possible submucosal cleft but in reading did not feel that this girl met the descriptions.
    I recommended she have the baby evaluated for the posterior tongue tie. I am considering having her try to ramp her supply back up since baby seems to do the best with the stronger flow.
   Any suggestions?

Thank you,

Allyson Michaels RN, IBCLC
Charlottesville, VA






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