Hi Lactnetters,
PTP- I am working with a mom I worked with previously with her now 2 year
old son with TT not dx until 4 months and production was severely
impacted.  Baby #2 I saw at 4 days and identified common flags of tt, high
palate, couldn't stay on breast etc.  Could not feel or see a frenulum. I
offered referral if mom wanted 2nd opinion and she decided to wait for a
week.

Week later baby had started clicking and weight was within lower normal
limits.  Mom ready for referral so sent her over to see an very respected
tt doc who found nothing either and suggested some different positioning
ideas which actually made feeding harder.

Baby is now 2months 23 days.  I have seen them every two weeks with average
weight gain plodding along at around 4ozs per week.  However, she is long
so she looks very thin.  Today she just didn't look good.

Mom was pumping a couple times a day to protect production but stopped for
a couple of weeks.  She is taking Mother's Milk Plus and feels she sees
more swallows. She has done one session of CST but cannot afford more
although she saw a slight improvement.  Stooling and fussiness have
improved since mom removed all dairy from her diet.  Baby requests feeding
about every 2 hours and while mom says she is done in about 10-15 minutes,
observing her feeding today I saw that baby never relaxed during the
feeding, mom is holding the breast in baby's mouth, and baby is off and
on once the MER is over and I suspect baby stopped feeding not from
satiation but from muscle fatigue. Clicking with every suck during the MER.

I was able to get baby to suck on my gloved finger (why don't they make
milk flavored gloves!?) and the posterior tongue is totally humped up, when
I massage it down she starts gagging.  Minimal negative pressure....

I've recommended re-starting pumping (I seriously doubt this little gal can
maintain production much less increase it) and supplementing with cup or
bottle.

This totally walks like a duck (tt) and clucks like a duck (tt) but I
cannot see or feel where the restriction is.   Should we consider another
MD eval?  Should we request referral for OT?  Ideas of where to go, please!
Thanks,
Michele

-- 
*Michele L. Crockett, IBCLC, PCPA, LLLL*

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