Good  Morning,
I am seeking some advice if I may.  We presently have a full term baby  in 
our NICU that is requiring oral gastric feeds.  On consult for him are  an ENT 
as well as genetics.  They are thinking that he has tracheomalacia  as well as 
a possible "syndrome."  He has a very difficult time breathing  at all times, 
not just during feeds.  On exam, he has a very small mouth,  receding chin and 
his tongue is very short and thick.  He also has a thick  frenulum which I 
believe causes the tongue to stay up to the roof of the  mouth.  The palate is 
also somewhat flat.  I did put a gloved finger  in his mouth to see what his 
suck was like, which is uncoordinated and the  tongue is not long enough to 
extend past the gum line.  The tongue also  does not curl around the nipple.  I 
gave mom a nipple shield, placed the  baby in the football hold, with him 
sitting up as much as possible and then  helped her get him in a very deep 
asymmetrical latch.  Mom is large  breasted so I had her use the C hold to make a "sand 
which" for the baby.   He appeared to be making some good attempts, but them 
became fatigued and lost  whatever coordination he had and began to push with 
the tip of his tongue and  bite using his gums.  When he came off of the 
breast there was some milk in  the shield, mom is still at colostrum phase.  My 
question is this, what  more can I do for this baby?  He actually does not suck 
effectively with  the artificial nipple either.  I asked for a speech therapy 
consult.   I have to be honest though, our therapist is not peds or 
breastfeeding trained  but he is better than nothing.
Any and all advice you can share with me is appreciated.
Thank you so much,
Lori Lindsey , RN IBCLC
 
 









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