Help!  With permission to post:  I am working with a mom who is one of our WIC Peer Counselors and and experienced mom of 4 exclusively breastfed children.  Baby #4 was born April 5th in an completely unmedicated home water birth---dad caught as midwife did not arrive prior to birth.  Dad is not sure how baby presented but reported it didn't look 'right'.  He may have had his hands on his cheeks (think of the kid in Home Alone with his hands on his cheeks!).  He had quite a bit of bruising on that area of his face.  No molding I could see 20 hours later.  Weight 7'4".  



Mom has had uncomfortable latch issues with all kids that was likely caused by being 36-38 weeks gestation--all natural, not induced.  Baby #4 was actually at 40 weeks.  Other kids latch resolved with some basic position changes etc.  Worked with this little guy with out much luck.  His tongue was 'glued' to the roof of his mouth and he would not lower it.  Mom had a Lactina for back-up and to in sure good breast emptying especially on day 2.   Her production remains good, great MERs.  Continued offering the breast and backing up with EBM via dropper when baby was frustrated or mom was.  Had a brief episode with elevated jaundice resolved without any therapies.  



Saw mom and baby on day 6---dehydrated and losing weight!  Baby was at 6'6" and did not look good.  Latch awful.  Tongue up, small mouth and barely could extend tongue to bottom gumline.  It appears to me that the tongue is short?  Chin is recessed but not more than her other children's were. Okay wet diapers/marginal stooling. Mom left with MD appointment the next morning for follow-up, and instructions to pump more frequently and supplement EBM 2 or more ozs. every nursing.  MD confirmed my recommendations the next day although baby was not dehydrated by that time, fortunately.  She scheduled a follow-up in 3 days.  Within 24 hours baby was running a temp of 100.4 and rose to 104 by admit to ER locally.  UTI identified caused by posterior urethra valve, transferred to Seattle Children's Hospital.  IV antibiotics for four days then surgery to remove the valve and another 10 days of IV antifbiotics.  Mom continues to pump and supplement EBM.  No problems with breastfeeding in hospital but no support for solving suck issues.  I am not sure how assertive mom was about it---pretty overwhelming medical stuff already! 



Baby is home at 7'3" yesterday (5 weeks old) and just maintaining.  He spits up the supplement even in small amounts and held upright following feeds.  He wants to suck 'all the time'. Output is meeting minimum standards.  Tongue is down during nursing now due to mom using a nipple shield to help him. Mom can see milk leak out his mouth while nursing and she can see him swallowing. No choking or gagging or respiratory changes while nursing.  Nephrologist (spelling?) told mom that babies with these problems don't gain easily and if he doesn't begin gaining they will recommend a feeding tube.  Only exclusively (if you don't count the meds he is on) BF baby they've ever seen!  They have put him on antibiotics 'just in case' and he takes a 'salt' medication to help his kidneys. 



Baby continues to slide down the nipple in order to suck, tires quickly.  Over the weekend I took her a baby scale and a Lact-Aid supplementer someone dropped off with me...right now we need to help this baby gain a few ounces!  My gut says it has to be baby's tongue or something he can't manage to do with the suck.  I don't have a lot of experience here and it doesn't look like the tongue-ties I have seen a lot of...but not normal either.  This mom is my daughter's best friend and she nearly lived with us during high school years...and now she works with me and is like my daughter!  So sometimes I question what I am seeing too, due to the emotional connection.  I would like to have her evaluated by someone with more knowledge on this but two leading experts kind of glanced at baby in hospital (didn't even examine oral structures!) and said everything looked fine. And another nearby resource doesn't think she can help although she has only talked to mom on phone and me.  Again mom may not be very asser tive when she talks with them....I just keep coming back to his tongue doesn't look 'right' to me!  Maybe I am nuts!  Any ideas or if you have worked with a baby with his problems....we are open to any ideas!  Wish I had taken photos of his mouth this weekend...maybe I will try that this week.  Mom reports today that baby is maintaining weight over weekend but gaining.  She also says that it appears to her that his tongue pulls slightly to the right when he tries to extend it.  Needless to say we are both looking all the time! 



Thanks! 

Michele L. Crockett, IBCLC, LLLL, PCPA 




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