Jaye,
The first thing that strikes me about this baby is that functionally she appears to be tongue-tied. I have been amazed by the number of babies I have seen who do not appear to have a frenulum to clip until the doc clips through the mucosa and the little band pops up to be clipped. I am really grateful to have a doc here (trained thankfully by Betty Coryllos) who is willing to consider function as significant in his assessment. I actually had one mom whose baby's tongue was clipped at 5 days pp and when I met her at 2 months, I sent her back to be reclipped and the doc said "there's no frenulum to clip", although we managed to get the labial frenulum clipped, which made for some improvement. When the doc I work with finally clipped the posterior tie on this little on, he could finally nurse without causing all the pain that caused mom the have thrush and vasospasms for weeks on end--I find thrush is caused by persistent damage from tongue-tie and does not heal until the tongue is released. I also find that the sucking that compensates for an inability to suckle causes an intense burning in and of itself. I also think that babies who have tongue-ties absolutely need to have structural release done after the clipping to allow for normalization of function. I think this piece is essential minimizes much of the lengthy reteaching that happens when tongues are clipped so late.

Jaye: "At any rate - I have a new question for a new mommy.  Baby is 6 wks old.

She has had chronic pain the entire time.  When she called me 2 weeks ago 
she told me she had been diagnosed with Thrush by her Dr and baby had also
been diagnosed.  She had been given nystatin it wasn't working what else
could she do.  She had told me that she had had burning pain for a couple
weeks prior, that it was getting worse.  (Silly me) I took the Dr's
diagnosis and gave her other options for treating thrush.  Well, after 2
weeks of trying this and that (Gentian Violet, APNO, Diflucan) there was
still NO improvement.  She asked me to come see her which I agreed to - it
was time to look at this in person.  Probably should have seen her 2 weeks
ago, but I never got from mom that the pain had started on day 1.I'm sure I
asked, but somehow it got lost in the whole thrush debate.  At any rate now
I am at a loss.

 Mom's nipples come out compressed after nursing - obvious minor trauma to
nipples.  Nipples BURN - areola's BURN - the area around the areola's BURN
now.  She is also having excruciating vasospasms in between nursing's.  Baby
nurses frequently and was gaining weight well up until 2 weeks ago when that
dropped off sharply (only 4 oz in 2 weeks).  Nipples are pink/red.  Baby
does have white 'stuff' on her tongue - but has been thoroughly treated for
thrush so I am not sure if this is still thrush and just a bad case of it or
if it is just a layer of milk.  Some of it does wipe off - some does not.
Bottom line:  mom's nipples hurt 24/7, the burning is always there and seems
to be getting worse, and nursing is very painful.  Milk supply is low.  Baby
appears to have a possible posterior tongue tie - but there is no frenulum
to clip - tongue notches to a degree, just behind the tip is always pulled
down when baby lifts her tongue and suck eval showed some back and forth
movement but not consistent, but also very tight strong suction at juncture
of soft and hard palate - my finger felt like it was being rubbed raw!
Tongue motion was sometimes good and sometimes not - but the tightness of
suction was amazing.  Now I know how to work with lack of suction how do you
relax that suction a bit?  No noticeable body issues or tightness in jaws or
neck areas.  Baby 'chews' at the breast using upper and lower lips
excessively to help with milking - lower lip looks 'chapped' when baby comes
off the breast.  Tired a nipple shield to see if that would help pain level
- baby did fine with it - latched deeply, got milk but pain was the same if
not worse for mom.  She won't be using that."




Jeanette,
Babies who favor one side like this usually have structural restriction from either the prenatal period or the birth that causes tension or pain when they turn to the other side. I would be suspicious that the inhibited MER is caused by the baby's inefficiency at breast and that perhaps nothing that you have observed with mom is really that significant except in the context of the baby's dysfunction. If the baby is pushing the bottle our of her mouth then the ped's argument that feeding is occurring is not even valid, as feeding is occurring against the baby's will and feeding is not something that ought to be done to someone. I know things might be a bit different on CA than in CT, but here most moms can take baby to a chiropractor without a referral. My experience has biased me in favor of working only with CSTs or chiropractors and PTs who do CST, as it has been my experience that they have a better grasp of normal feeding function than do OTs or speech therapists. I also find that the work they do (CST or integrated with CST) releases far more effectively. We are lucky here that we have chiropractors who do this work, but you might find a CST in the area who does as well--mom does not need a referral for a CST, although she will pay out of pocket. 



 


Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network LLC

 


 "This is an experienced mom of 5 - and she has done everything right - baby



is now appropriate weight for age, gaining beautifully and mom is pumping 12
times a day, totally meeting infant's needs with her milk.  She also "wears"
her baby all day long with a carrier that allows skin to skin (older
children are MUCH older, so she's not dealing with 3 toddlers, here).  

BUT breastfeeding is still not occurring - some of my observations:

Mom's nipples are very large and meaty 
Mom's let-down is slow, but does come when pumping

However, what has me concerned are the observations on the baby:
Whenever she lies on her back, she turns her head to the left and then
extends her head way up (if it were me sitting up, I'd be looking up at the
ceiling over my left shoulder)

She has a strong tongue-thrust pushing everything out of the mouth - bottle,
fingers (her own), mom's nipple.

Supplementation had originally been started using an SNS at the breast, but
as she did not consume adequate amounts of food (at the time formula as
mom's milk supply was very compromised), and the weight loss was dangerously
great, she supplemented with a bottle and continues to do so.

I did use a nipple shield at the last visit (the nipple hardly fits in the
standard one) and observed no milk gathering in its tip or any milk
transfer.  I did teach mom how to position baby at the breast using her
favorite position rather than trying to use a traditional cradle hold or
cross-cradle hold - baby relaxed at the breast for the first time, but
sucking was ineffective.  Actually baby looked "kind of" like the position
in Glover's Follow Me Mum.

I do believe things will get better as baby's mouth grows up to the nipple,
but was wondering about the extension as a symptom of concern...

>snip>

I was thinking of referring her for a Physical, developmental and oral
assessment (Speech therapists, occupational therapists do this in our area),
but am sure that the MD will say that as long as she can bottle-feed, this
is unnecessary - and in order to have the costs covered, she would have to
have a Primary Care Provider make the referral (sorry, a U.S. "managed care"
problem).  










 


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