I am working with a mom who had a baby on 1/6/97. Full term, 7pounds, 4
ounces,born with bilatteral cleft lip and palate, gum line intact. Fourth
baby, nursed the other three for over 9 months. (The mother had also been
born with cleft lip and palate.) The mother desires to breastfeed, has
little attention (I'm saying this in a positive way) on the cleft. In
hospital LC reports baby latches on fine.
I saw her in our clinic 1/13/97, baby weighed 6'14. Does appear to latch on
well, jaw excursions full, BUT, as suspected, with test weighs took 15cc.
Fine tuned position and latch, mom holding the breast in the mouth for the
baby. Mom has double electric rental, exclusive breastmilk at that point, has
given pumped milk in a Haberman 3 times a day.
Community Health Nurse saw baby 1/15/97 states baby latching well, baby
weighed 6' 8 (different scale) 4 ounces formula supp started as mom only had
pumped minimally.
Home visit today1/17/97. Baby weighs 6'12 (Same scale as 1/13/97) Does latch
well, I can not pull the lower lip down to see the tongue. Not fussy. Test
weighs 2cc and 4cc!!! On the Haberman took 2 ounces pumped milk in about 15
minutes without distress. On the Haberman the baby keeps his tongue almost
glued to the floor of his mouth and when his jaw drops the tongue goes with
it, I suspect he does a very similiar thing with the breast in his mouth so
the tongue is not being used to breastfeed and thus decrease supply, poor
wight gain and although he appears to latch, he obviously is not
breastfeeding.
Having little experience with clefts, how can this tongue action be changed -
the real question is, can breastfeeding be facilitated?
For the weekend she is going to pump at least 7 times a day, give 15ounces
minimally per day, suppl. with formula if she does not have enough
breastmilk, offer the breast as it is calming to him. I will see them on
Tuesday for a weight, which I think we will be correcting, but I would like
any suggestions for correcting the breastfeeding.
Thank you,
Robin Hollen RN IBCLC
Reno,Nevada
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