Hi,





OK this is a long one - but I have PTP from mum who is looking for support in terms of - where do we go from here - what can we try that we haven't.





Both I and she are aware there may not be an answer to what she's asking - and she is aware of my role and remit of knowledge (heavy on the counselling - no medical advice - she has enough medical advice).





This is copied from her words to me, so I am not missing anything out (well...) she has previously had ongoing input from TT practitioner, an IBCLC, and is still seeing neonatologist, dietitian, pead. The over-riding question is, "how do we get back to some breastfeeding?"





  *   Preemie, 33weeker, IUGR baby (query IUGR or more in terms of genetics?)

  *   28weeks now, and just over 4kg

  *   Tongue tie divided, no reattachment, capable of normal tongue function

  *   CMPA and soya allergy, using neocate as a fortifier, 1 scoop in 30ml of ebm, no water added

  *   hyper-sensitive gag reflex, can't tolerate bottle, dummy, sns or other oral methods that aren't breast

  *   NG Tube dependent and orally aversive

  *   exclusive tube feeding has coincided with /caused development of silent reflux (treated w omperazole)

  *   not ready for solids due to gag reflex (high risk of aspiration)

  *   discussions around g-tube in stomach

  *   seems to have 'forgotten' how to suck rhythmically, and can no longer suck to trigger letdown

  *   no longer initiates feeding - mum is concerned baby would go for hours without 'asking' if feeds weren't via tube





Genetic testing results are due back next week. There is no other underlying medical cause for the slow weight gain (all scans, assays etc clear)





Mum want's to BF, but she also wants baby to gain weight - bottles resulted in excessive and immediate vomitting (gag relex sensitivity) - she's also conscious that she will return to work and won't be exclsuively bf, but wants to be able to get to a stage where she can at least do morning/night feeds, so this isn't about exclusive BF.





1st baby didn't BF due to various support issues around reflux and is also CMPA, plus other allergies.





You don't need to tell me this is out of my remit - I am pretty aware of my boundaries 😊 I am mostly with her for listening and signposting.





Does anyone have any experience with a similar situation - or at least - pointers for mum for overcoming the oral aversion (should have mentioned this is predominantly triggered by repeated bouts of oral thrush).





Cheers!



El.









Eleanor Molloy



Research Fellow - DAPPLE Project - University of Birmingham



NCT Breastfeeding Counsellor

Consultant & Director - Coventry Slings

(Dipl. H.E.; MSc. Child Health)

Tel: 07786490252

@el_mo1331





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