Hi. Thanks to all of you for your input on this clicking baby. Barbara,
Thanks too for the hopeful suggestions. I don't worry about clicking that is
asymptomatic. Just about the pain associated with this one.

Mom called again tonight.  Here are Lisa Marasco's questions, which I will
answer.


* Is the baby totally clear of thrush? The itchy/burning sensations
     of that can surely cause some babies to click

**I realized this, and mom has Gentian Violet with her. baby seems clear and
mother has no more burning. She is considering using it anyway to make SURE.

   * Has the arching and hypertonic behavior desisted?  Any clue to the
     cause? What were your original interventions?

**They have gone away, yes. The cause? I have no idea. Was quite marked, but
has gone now.  Originally, we used the clutch hold to encourage the baby to
mold a bit, and gently put her into a C shape, instead of the rigid arching.
Baby really reacted to touch on her head, so we placed a thin blanket
between the hand and the head, and avoided touching the head area.

   * Have you assessed the family history of
     allergy/sensitivities/intolerances? (Baby may be itching a scratchy
     palate)

** No history of allergies. No signs of overactive MER, except occasional
gulping. Clicking is worse on one side, less when lying down. Clicking is
more on the side that is fuller/more productive.

Mother has been inserting finger, and feels that baby is putting back of
tongue UP. Not all the time, but some of the time, and this is when the
CLICK happens.

I usually try putting baby in a position that has her above the breast,
such as a rock-back foot ball hold, or having mom lie on her back and
baby lay prone on top of  mom. Such positions "force" the baby to hold
on to the breast more because they must now work against gravity. If any
of the above apply, though, they would need to be addressed before it
would all come together. I assume MER is not excessively strong?

**NOpe, not excessively strong. Just drips. NO sprays.

I have noticed that some of these babies seem to gradually improve when
I am doing my digital suck assessment.  At first they are frequently
losing the cupping under my finger, but gradually they "tighten up" if
they hang out and suck for a few/several minutes.   If so, doing the
suck training you suggest until the sucking pattern settles down can be
helpful. Other babies won't cooperate with such an exercise unless there
is milk flow, such as with SNS or syringe.

** Baby gets mad occasionally sucking on finger. What to do about the HUMP
at the back of the tongue that comes up occasionally?

Kathleen



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Kathleen B. Bruce, BSN, IBCLC co-owner Lactnet,TLC, Indep. Consultant
in beautiful Williston, Vermont, USA
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