Hello to All,
Any sage suggestions wd be most welcome with the following case:
  Term baby girl, born at our lovely out of hospital birth center.  I was
their birth and postpartum nurse, and i sent them home with a nipple shield
, without which i am certain this baby would not have fed at breast.  Mom
has small, very high breasts without much tissue elasticity.  Baby has
short, tight jaw excursions, tends to arch a lot, and has been a very
sleepy, slow feeder from the get-go.  The birth went well, and mom received
no medication.
  This babe is now 2 weeks old and has not made birth wt. yet  (about 3 oz
under today).  At her last visit, after 4 days of pumping and supplementing
(fingerfeeding with an SNS, parents were asked to supplement at breast, but
they feel it is too much of a hassle with the shield) she had gained 5oz in
4 days.  Today she'd lost 0.2 oz in 3 days.  I am encouraging the baby's HCP
to see her sooner than her scheduled well visit (3 days hence) to r/o any
underlying illness; I've asked the parents to increase total supplement
volume; and i plan to meet with them again in 1-2 days to work with the baby
when she is >.awake and hungry.
  Baby latches on without the shield 2-3 times /day, but according to mom,
sucks a few times and lets go.  I've been using shields for failure to latch
kids like this for at least 4 years, and never yet had a case of reduced
milk transfer or compromised wt gain.  But in this case i feel the baby's
tight tone in the lower jaw is inhibiting a good latch. I've also asked mom
to hold the baby's chin down during feeds to improve latch& milk transfer.
  Now, from all those brilliant and experienced minds of lactation out
there, what else do you suggest?
   Warm (90 degree) thanks from Martha Johnson RN IBCLC, EUGENE, OREGON