I am asking for some thoughts on a client I saw today. Her baby is 3 1/2 months old and Mom has had difficulty with latching since birth. On exam of the baby she is chubby and happy, normal palate, tongue, and muscle tone. Mom has soft breasts with a prominent nipple. On digital exam the baby seems to suck adequately, but after 1-2 minutes, will start to push out my finger with her tongue.

On observation of nursing the Mom holds the baby properly and places the nipple and areolar tissue in the baby's mouth. The baby then starts wiggling and squirming but continues to nurse. Within 2-3 minutes she has pushed the breast out of her mouth and is on the tip of the nipple. Upon removal of the baby from the breast the nipple is creased with a white line.  Mom does not appear to have over-active let-down, no milk dripping on the other side, baby not coughing or choking. Upon hand expression she flows readily, so it appears she has an adequate milk supply. No signs of yeast infection in Mom or baby.The baby spits up a lot, and Mom reports when the baby lies on her right side to nurse she sees milk dripping out of her nose. Mom has taken baby to the Pediatrician several times for exams and because the baby does not appear to be in any discomfort,(no excessive gas or crying) and she is growing well they have not determined any problem. Mom has 4 other children under 7 has been trying to keep this up through her discomfort and the baby's antics at the breast. Mom has tried many different positions, none seem to make a difference. The baby wants to nurse every 1-2 1/2 hours, and Mom just recently started a pacifier and 1-2 bottle feedings a day in the evening. I am going to call her Pediatrician to discuss the milk coming out of the nose to see if she feels it could be reflux. Any other thoughts?   Possible allergies? 

TIA
Dianne  IBCLC
Florida

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