I have been consulting with a patient that delivered
at 38 weeks with vaccuum extraction & epidural. 3 days
old. Infant has somewhat unusual facies. Ears are
lowset and he has a hypospadias and heart murmur.  Mom
wants to breastfeed but baby constantly sucks in his
lower lip and sucks his tongue. He keeps his tongue
firmly planted in his palate.  The tongue will extend
past the gums and he will suck your finger with his
tongue cupped around it but no peristaltic movement
felt.  After >24hrs without nursing, the baby was
syringe fed EBM using sucking exercises during feed.
Baby exhibits very little rooting reflex.  He has
nursed a few times briefly using a nipple shield that
can "force" his tongue down.  He is very likely to
slip his tongue back on top of the nipple and give
lots of "lip" action that fools the parents and nurses
into believing he is nursing well.  I have told mom to
do pre and post BF wgts to help determine milk
transfer. I have gotten a speech therapist to see the
patient but she was unable to come up with anything
other that suck exercises to the parents.  She is VERY
critical of the syringe feeding telling parents baby
can likely aspirate using this technique and our
"forcing" his tongue down is causing an oral aversion.
I don't know what else to try.  We did get him to
bottle feed EBM as a trial of what he is capable of .
He took 60cc EBM well but the nipple did have to be
"forced" on top of the tongue.  Any ideas or who else
I might refer him to. The pedi has ordered a neonatal
head sono this p.m. to r/o hemorrhages,etc.


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