Mom's third baby.  Nursed first 2 babies by using an SNS for the first couple of months until baby's mouths became big enough for a good latch with mom's large nipples.  Day 5 poor transfer at first visit and decided was same issue with size discrepancy.  Mom protected supply. Mom was attempting nursing few times a day, but states baby does not pull on the breast like other babies and SNS does not help with transfer.  I thought there might be a tongue tie and at this point mom decided to have it investigated. Baby had a posterior tongue tie and lip tie revision which ended up reattaching, was reopened, and then formed scar tissue at the sight.  Tongue is loser but slightly tight and mom states suck is stronger and transferred some milk, but defiantly not a full feed. Baby now 6 weeks old.  Saw 2 different speech pathologist's.  Mom is working on strengthening suck, jaw etc. She has been finger feeding and states that tongue cupping has much improved.  She also does a bottle and it takes 20 min for a feed with the bottle.  Now at 8 weeks, the baby one time transferred 4 ounces over 1 1/2 hours on the breast, but has never done anything remotely close to that again. She is still seeing speech, finger feeding and bottle feeding and tries the SNS at the breast, but the baby will latch and go to seep within 7 minutes even with switch nursing and or SNS. The only way he stays on actively for 7 minutes is if he is stimulated by being out and about with things going on ands is wide awake. Otherwise sucks and swallows with first letdown only.  I recommended to try movement with nursing, example walking , rocking, bouncing and trying the bathtub. What else??? Any thoughts??

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