I've gone through some of the archives and haven't found a good solution, so I'm hoping maybe I've missed something. PTP.

Baby is 8 weeks old.  First time mom.  No medical issues for either. Unremarkable pregnancy.  Baby exclusively breastfed till this week.  Weight gain has been good.

On observation, baby has a submucosal frenulum, bubble palate.  I suspect posterior tie, but baby would not let me use "the Kotlow maneuver" on her.  Any time I attempted to have her suck on my finger or move her tongue up she gagged.  Mom has been charting pre/post weighs and knows baby transfers 3 ounces in the morning and gets progressively less all day until 4-6pm when she only transfers 1.8 after an hour.  Baby is not sleeping through the night and feeding about every 3 hours.  Mom is responding to feeding cues, doing lots of skin to skin and baby wearing.  Family co-sleeps.

Baby will not open mouth at the breast (combination bad habit and I suspect mom sprays a bit).  Adjusted mom's positioning to laid back for spray, encouraged baby to slowly be brought tighter in through the shoulders.  Baby basically refused to keep the nipple/breast in the mouth when brought to close.  I suspect that the nipple may be triggering the gag reflex and so baby has been relying on mom's let down to get fed.  This of course isn't working now.

Mom is starting another round of fenugreek, with more pumping and will be doing compressions with every feed.  My question is is what to do about the gag reflex?  Or is there something I'm missing?  Mom really wants to succeed but she is struggling and her supply is plummeting.

Lea Rivera Todaro
Brooklyn, NY

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