Hello wise ones,

I am currently working with a lovely mother and baby dyad (I have permission to post) who presented with OER, tight labial frenulum, posterior tongue tie and seriously damaged nipples in mom. Babe is gaining like gangbusters. 

First visit, we worked on the latch. Baby was clicking and biting. Had a difficult birth with suction device used on head during birth with small hematoma on back of head, deep oral suctioning due to meconium staining resulting in some clamping during feeding. Saw some baby protecting his airway and mild oral aversion during first visit. Takes breast with no aversion, though. But, baby gags easily. 

Latch was corrected with referral to DDS who does great TT and Labial Fren laser work. Parents were a bit overwhelmed and not on board right away with seeing DDS for frenecomies. After several phone calls, babe had lip correction done. Second visit, feeding somewhat better, but the tongue was still a problem. DDS contacted me and we both agreed the tongue needed laser frenectomy. This was done last week.  DDS contacted me to see mom again to help with latch with new tongue skills. 

Mom is still in pain, baby is still clicking some. I will see her tomorrow, looking for thrush, considering shield, as mom was considering taking baby off of breast completely for a week to let nipples heal (she's in pain) and I felt the shield may help with less damage to the baby's learning new muscle memory than a week or even a few days of bottle use. It may help him keep his tongue in proper position, depending on what I see and feel tomorrow when I see him. 

OER has been treated, greatly fewer green stools (almost none) and seemingly less tummy trouble. Despite OER, (it can be heard easily, she ejects within 3-6 seconds of latch, frequent ejections during each feed, large number of diapers and great weight gain) mom does NOT spray, dribble or leak most of the time when attempts are made to remove baby from breast to allow first ejection to flow into burp rag. (Babe was displaying foremilk overload, it appeared at first visit. That seems to have resolved at this time. Mom intuitively started very flexible "using one breast as often as he likes for a few hours" method independent of any instruction. Good instincts in mom. She says this has helped, and baby is gaining well. The breast usage is very flexible, NO rigid "block feeding" of old being used.) 

I think Mom may be close to giving up, despite baby doing fairly well. She is still dreading feedings several times a day. 

Suggestion was made from me for cranial sacral adjustment, but mom is on the edge of burn out from many suggestions from not just myself but others. 

I will see her tomorrow to examine baby, witness and help with latch, assess for thrush etc. 

Baby is now 5 weeks old, very engaging, cooing, smiling, seems happy and well fed. Mom is in intermittent serious pain, latch is great while I am there, but she sees squashed nipple at times after feeding and has "burning pain for 2 hours after showering." On some days the nipples are not painful at all. Very frustrating for all. It doesn't seem like classic thrush to me. 

I'm thinking Baby hasn't figured out how to properly use his tongue yet, but has some odd habits from 4 weeks with tongue fairly glued to the floor of his mouth, now those muscles are being used ON her nipple improperly. (Mom was given finger/tongue exercises, but baby still gags easily when fingers are placed in his mouth, last I checked with her.) 

I hope I'm not missing anything. Tough case. I see a lot of TT and TLF, most resolve after lasering fairly well. 

Thank you all in advance,

Mary Jozwiak, IBCLC, RLC
Board Certified Lactation Consultant, Post Partum Doula
Birthwaysinc.

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