Bryna writes:

Baby has  what the ENT calls a "borderline" posterior tongue restriction, 
but is gaining  weight well and mom's nipples have healed and the dyad is 
breastfeeding very  well, despite "small" latches as reported by mother. 
Mom is due to return  to work in October, and after 7 weeks and 
establishment of good breastfeeding,  the midwife suggested introduction of bottles. 
Family complied, but baby  refused. For the past 3 weeks, family has been 
working toward this goal, as  baby is now 10-11 weeks. 

We have tried paced bottle feeding baby while  skin to skin with the 
father, mother left the house, tried introducing a straw  with some limited 
success, tried feeding baby whilst she was upright propped  on dad's knees, making 
sure to use bottle to stimulate baby's high-arched  palate. 
~~~ Although this baby may eventually accept a bottle from whoever will be  
caring her while mom works at home, there are several factors that may be  
involved in what they are seeing now. Two possible solutions are being ruled 
out  before they are even really observed: cup feeding and reverse cycling. 
This may  or may not change if baby continues. Another thing is that babies 
with high  palates and/or posterior restrictions often have several things 
they are dealing  with that make bottlefeeding feel either unsafe, 
uncomfortable or just possibly  weird. The mom's breast conforms to the shape of the 
palate, but no artificial  nipple does this. It can "poke" a baby in the 
"naive" or very sensitive palate  area and be a negative sensation for this 
baby when it might be fine for another  baby. Another issue is that a tongue 
restriction can mean that a baby does not  have the full range of 
motion/grooving/whatever skill to control milk well when  it comes out of anything other 
than mom's breast. The breast-mouth interplay is  different in both 
sensation and stability, because baby's mouth is filled and  conformed to, so this 
baby may be reacting to this "intrusion" or a lowered  ability to move and 
control milk transfer in a way that feels comfortable and  safe. Some babies 
will overcome these negative sensations in time, others we are  simply 
asking for too much ( we still live in a society where bottles are seen  as 
normal and families often don't realize that this foreign object can be  an 
uncomfortable thing which feels weird or unsafe. ) Perhaps helping the family  to 
understand this, they will understand their options for this baby better. I 
 hope this helps, it's a complicated issue and often does create problems 
for  families who think this should be so easy, or they've done something 
wrong. I've  seen only two or three little ones who refused bottles initially, 
and  never changed ( in about 25 years) and the moms  actually  quit their 
jobs and worked at home and were available for baby to  breastfeed. The time 
when this was the only option, in retrospect, was short.  This baby may end 
up cup feeding, reverse cycling, breastfeeding only til ready  for solids, 
who knows...
 
Peace,
Judy 



Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
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