thank you to all for your input here.
Catherine has some questions:
re the hoarse cry I was thinking more along the lines of ? vocal cord
paralysis. Did not notice any breathing problems, and he bottled better than
I thought he would. No stridor. No signs of stress. (I was anticipating the
worst!) He did suck with a 'sucking on a straw' look about it rather than a
milking action, if you can picture what I mean. (Sucked in cheeks, L more
obvious than R). I discussed getting the teat in as far as possible and to
hold the bottle almost horizontal. We did not have Habermann at work that I
could find as I was going to take it out to the home with me (the one we had
has 'grown legs') and mum didn't look too enthusiastic when I told her the
cost. As I said I was reluctant to try a supply line as I just didn't think
it was the way to go and it reassuring to hear what you have to say,
confirms my gut feelings. Mum had tried cupping but felt he spilt too much,
understandably. If she is happy to breast and then comp with bottle then at
this stage I think we support her with that (or try Habermann)
you suggest:
........ In this baby's case, perhaps laying on the
> side of the facial nerve palsy or muscle absence defect (which ever it
> turns out to be) provides support to the face that allows the mouth to
> function better. I'd encourage mom to use that position when she can.
> For other feeding positions, modify the dancer hand position to
> provide support from mom's thumb along the side of the mandible to the
> angle of the lip, right where the missing muscle would otherwise be.
I will follow this through thanks
As for the tongue no I didn't notice a humping. The more I think about it,
the more I am inclined to think it was short if anything, but I need to have
a second look.
Unfortunately I am not at work today but will phone (I am as curious as
anything!!) and see baby again tomorrow. I will go back over things again to
confirm what I saw.
Yes the history of trauma (forceps, bruising, cephalhematoma) says to me
that this is the obvious thing to consider. I would be interested in a
speech therapists opinion.
As for his general tone, when I first woke him I noticed that the right hand
(it's the R side that is the problem)was half clenched and the left was
fully clenched. In my mind I am thinking this is not right. His tone and
strength however seemed otherwise ok, so it may be nothing but again I want
to have another look.
The ears....yep.... you are right re the genetics! You know I was so focused
on the strange ears (and mouth etc)that I didn't look at where they were
set, myself, although no comments in notes to say anyone else has noticed
(which also doesn't mean anything ;-) ! ). The more I think over this the
more I want to go back and check/recheck things.
Lets see what transpires today and I will keep you posted.
And *Thank you* Catherine, you are such a great resource!
Do you mind if I pass on your answers to the LC who is seeing this baby
today??
Iona, you also have an interesting case, I looked it up with google, quite
challenging! I will keep this in the back of my mind too.
Dee, your suggestion of CST is a good one. I actually mentioned this to mum
as something we may consider 'down the track'. I am in a difficult situation
in that this baby is an 'inpatient' of the hospital, we have conservative
doctors who would most likely not agree with this approach. So I have
planted the seed (with caution) for the moment. I also feel I need a
diagnosis, which I don't have. And my priority at the moment is getting food
in to this baby and building up strength then we can look at alternatives.
So we will keep this up our sleeves!
Thanks all once again
Karen Clements
IBCLC Melb Aust
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