I have PTP. fFirst time mother called last week for an appointment for her 4 week old. When she came in and I asked what brought her in, her response was "my baby sucks on my breast like she does on a bottle". Oral exam within normal limits. Tongue movement though was not coordinated. She would pull several times and then her tongue would be behind her gum. Mother had been supplementing within days after delivery for weight loss. She has continued to supplement and pump after several feedings a day. She breastfeeds every 2 hours, says the feeds take almost one hour and does not hear frequent swallows. Infant gets 1-2 oz in the am, 2-4 oz in the evening by her or her husband. Husband tends to give the 4oz as he feels that his daughter should not be hungry. Infant gained 1oz a day in the 1st 2 weeks and in the last week, gained 1/2oz a day. Mother pumps after her am feeding and gets up to 5 oz and in the evening 2 oz. Mother had an uneventful delivery and had an epidural for only a few hours. 


At the breast, this little girl did have  a vigorous suck with pulls for the first 5-ish minutes. Then her suck became more irregular-like what I felt on my finger. Mother's breasts were dripping milk. Breast compressions did elicit more swallows but overall, not much different. Mother was unaware of some of the swallow sounds. They were not gulps but were 1-2:1 sucks to swallows at first and then rare. Intake at breast was slightly over 1oz after 15 minutes in a pre and post feeding weight.


My impression is that this infant has learned to live the life off mother's MER and then does not pull to work the breast after that. I encouraged her to try pumping more frequently and I placed a call to her peds to see about an OT/PT/speech pathologist consult for suck training. I tried to look in the archives for nipple types that would be more helpful for her but have not been able to access. She is currently using the Dr Brown's and I instructed her on pacing the feedings. She said she tried the Breastflow bottle but the infant did not like it. Did I read on this list that the Breastflow would make her work harder? 





Any suggestions?


TIA,


Allyson MIchaels, RN, IBCLC



             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome