My baby number 6 had these symptoms. She was diagnosed (in a few months)
with low tone in the jaw and tongue. The only treatment - keep nursing -
this will exercise the muscles to get them into "working condition".
DD lived in my bed in the infant seat (did a mention a nasty case of reflux
?) for the first 9 months. And I fed her every hour for a few minutes at the
time - otherwise she threw up the whole feed. In the beginning I have mainly
expressed my milk into her mouth, letting her suck as much as she wanted to
(but she herself removed very little milk).
It got better after on, but never up to what I am used to and what the next
baby did from day one.
I exclusively breastfed her until she was 18 months old, I was pregnant and
my milk gave out. It took a lot of time, patience and commitment on my part.
And patience and tolerance from my family. The worst part was force-nursing
the baby that did not like eating. But it can be done. DD is now a cute
almost 4 year-old, smaller than many of her peers, but her muscle tone
development has cote up. By the way she also did not say a word until she
turned 3.
All the best.
--
Henya
Migdal HaEmek, Israel
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On Fri, Oct 7, 2011 at 9:52 PM, Amy Peterson, BS, IBCLC <[log in to unmask]>wrote:
> Jeanette,
> Yes! Good observations. A couple thoughts from me...
> Part 1: In my experience, I believe that low oral tone/strength has a
> disaterous effect on breastfeeding, and is usually not recognized. Not only
> does lack of lip tone/strength cause loss of vacuum, but many of these
> babies compensate for this low tone by pinching the nipple between the
> tongue and palate. (the back of the mouth works overtime since the front
> of the mouth isn't doing it's part) Sometimes we can have a clue by looking
> at the baby's mouth. Are both lips visible? Can you see the entire top lip
> at rest, or are the "sides" hidden? Are the baby's lips visible while
> breastfeeding, or do they roll in? With the bottle? Ideally, we can see
> the the entire lip (top and bottom) while the baby feeds. Sometimes the
> problem is not the lips, but the jaw. If baby has an exaggerated downward
> movement, sometimes the lips will follow and break suction.
>
> Trying the usual things doesn't work, because the baby needs targeted
> strengthening, not just calories. In the meantime, baby may not gain
> appropriately, and mother's milk supply may be in jeopardy. After all, baby
> nurses "all the time" and mom doesn't realize things are going down hill
> while they try "the usual." I agree with you that these babies often do
> not obtain enough milk with compression during nursing, and the sns usually
> doesn't help, either.
>
> A referral to an SLP or OT is a great place to start. There is also a
> program in the US that can be helpful. In Idaho, it's called the
> Infant-Toddler Program--but it is a federal program funded through IDEA. It
> takes a doctor's referral, but then, often, the state pays for initial
> services with the SLP or OT. Of course, there are qualification guidelines,
> but what a great resource to have. I keep the referral form as well as a
> form letter I made for docs, to speed up the process. I also have developed
> a working relationship with a couple SLPs/OTs who help speed up the process
> by adjusting their schedules to see new babies.
>
> Part 2: the bottle. Babies can have a terrible lip seal on a nipple for a
> few reasons. With the babies you saw, it is probably related to low tone.
> But for any baby, if the nipple shape isn't a good match for the baby's
> mouth, or if the nipple length is too long, or the base too wide, the lips
> will not seal; we will observe gaps in the corners of the baby's mouth, or
> leaking with a poor seal. A different nipple shape needs to be tried in
> this case. Also, if the flow is too fast, soem babies will keep the lip
> seal loose so the excess can run out. Sometimes a baby will have a good
> seal on the breast but not the bottle, so a different shape is needed. But
> often (like with your two babies) we don't noticed a poor seal on the breast
> if the baby is snuggled in tightly. Chances are your babies have a poor
> seal on both breast and bottle. However, you might be able to improve the
> baby's seal by choosing a different nipple in the meantime. It won't
> improve strength, but will at least get the baby using better mouth
> placement while mom seeks further help.
>
> Sorry I don't have a fast solution to share. But yes--you are on to
> something!
> Amy Peterson, IBCLC
> co-author Balancing Breast and Bottle: Reaching Your Breastfeeding Goals
> (written with an SLP after years of working together to resolve problems
> like the ones you decribed)
>
>
>
>
>
>
>
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