Hi Kika
It was so great to meet you, finally, in Spain, and now I know who
I'm talking to!
I'm really intrigued by your description of the month-old baby whose
gag reflex is triggered by stimulation to the palate, even far
forward in the mouth just behind the alveolar ridge, whereas he's OK
when the mother slides the bottle teat along the tongue to avoid the
palate. How clever of her. But it's almost as if the baby has got
his reflexes wired the wrong way around.... What must be frustrating
too is that when mom uses the nipple shield there is a strange kind
of disorganized suck but no swallowing? Low weight gain babies seem
to like "flow" before they will suck properly, so the reason for this
strange suck could this be because her milk supply is still actually
quite low and/or she's not letting down with the shield (is it full
of milk when she takes it out of the baby's mouth?, is there
dripping?) It could also well be that when she's had a chance to
build her milk supply back up (expressing/pumping often??) that she
will have more success with the shield. It could also be that the
baby's failure to actually "latch" on to the real nipple is that it's
shorter and less of a stimulus - I would say to the palate but
further back than just behind the alveolar ridge.... :-)
I do find that FTT or very low-gain babies just _don't_ breastfeed
effectively until they've caught up to the weight they should be, so
it could be that for now, this baby really needs and benefits from
the super-stimulus of the bottle-teat, and that if everyone is
patient, as you've suggested, once he's caught up the lost weight
he'll become more active at the breast. It might also be that if he
has a couple more weeks of "easy" feeding with the bottle that he
will a) become stronger and more competent and b) will come to
"expect" it to be easy at the breast too, and latch a whole lot more
easily - I've seen that happen. Consequently, I might even be
tempted to suggest to the mom that she suspend all attempts to
breastfeed direct for now, with or without the shield, and focus her
energies on re-building her milk supply and feeding EBM and formula
by bottle to get the weight on. I'd try and schedule a follow-up in
a couple of weeks or whenever he's caught up to go over the latching
again, as if he was a newborn, and see what happens..... Thank
heavens the mom consulted you and didn't follow the advice of others
who said take away the bottle.... the first rule being to Feed the
Baby... CST sounds like a very good idea too, possibly to take care
of disturbed reflexes from the difficult birth... I hope you can
keep us posted Kika - I'd love to know how it turns out.
Pamela Morrison IBCLC
Rustington, England
-------------------------------
Date: Tue, 2 Jun 2015 18:38:45 +0200
From: Kika Baeza <[log in to unmask]>
Subject: Re: breast refusal, gag reflex, nipple shield
Following Cathy and Pam's thread...
Saw a baby this past week that completely baffled me. Month old child,
being breastfed with nipple shield and supplemented with bottle fed mother
milk and formula because he was failing to thrive.
Mother 's reason to consult was that she wanted to wean off the shield
because she thought it was the reason for the ftt.
Baby"s oral assessment showed normal structures and a surprisingly marked
gag reflex, which was activated by just placing my finger at the front of
the hard palate, almost right behind the alveolar ridge.
Mom had learned to put the bottle into his mouth sliding it on his tongue
so he did not gag.
What surprised me was that he did not gag with the nipple shield. He did
not suckle effectively either, he had a strange fibrilating-rolling
movement (can't describe it better) with no swallowing, but the latch was
surprisingly deep with no gag.
Without the shield he would place his open mouth on the nipple and do
nothing. He did not explore it with his tongue except once very
tentatively. Nothing we tried (and I tried all the things Cathy describes
to the best of my ability) got him to latch.
Seeing all this, added to him being a breech baby born by c-section, I have
sent him to CST with the very best therapist I know. But I could not
interpret all these symptoms nor help this dyad on the latch issue.
Fortunately mom was happy with the support and the consultation since
everyone had been telling her baby was a great breastfeeder and to just
wean him off the formula. She was glad to confirm her gut feeling that
something was wrong.
Any wise ideas? There is so much to learn!!
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