A 17 day old baby was admitted to our pediatric unit with severe dehydration
and a 25% weight loss.  The mother had nursed her other three children for
more than a year each so she knew what she was doing.  The baby never latched
on well by her report.  I saw the baby on her 2nd hospital day and the baby
had been supplemented with EBM & ABM by bottle.  The baby was very weak and
it was difficult to finger feed this baby.  The mother increased pumping and
her supply started to come back.  This was her 4th C/S.  The other three were
bottle fed the "first few days" and then went to breast with no problems.  I
saw the baby yesterday on day 5.  The baby was vigorous, had gained over a
pound and was ready for discharge.  I observed the baby had a pronounced
click while at breast.  With much effort we were able to achieve latch with a
few nutritive sucks, however the baby's tongue would push back the mother's
long wide nipple.  I finger fed and taught the mother to do this.  The click
was evident with breast, bottle, finger feeding.  I spoke to our house
pediatrician, a speech pathologist at the cranio-facial center we refer to,
and a physical therapist to discuss the possibility of a submucosal cleft
palate.   The baby was not examined for this as this baby is being followed
by another pediatrician not affiliated with our hospital.  The baby did not
present with overt submucosal cleft and if the baby had anything it was
occult which is not treated.  My question for all you lactnetter is:  What
would be the treatment plan for this baby if indeed the baby was diagnosed
with this problem?  I plan on suggesting a referral for evaluation when I
speak to her follow-up pediatrician today.  This mother is now pumping,
offering breast, and supplementing with EBM and ABM.  She is a full time at
home mother who is very committed to breastfeeding. Thank you for any
suggestions!