Hi Eleanor and all,
While this sounds much more complicated than my more recent refusal
cases, I do wonder if some of the TT releases may be a reason for
increased oral aversion. I have recently had a number of TT and lip
tie cases where the mother has used laser treatment. While the
babies had been (ineffectively) feeding, they then began to refuse
anything in their mouths.
I have found it very hard to get the babies back to the breast.
Generally I try working with mums on skin-to-skin contact, and
gradually move to soft cheek,chin and then lip touch. This doesn't
always work, but sometimes it does help reduce the anxiety that the
mum is feeling and can help mum and baby reconnect.
This situation does sound much more complex but may help the mum
reduce some of her anxieties and worries.
HTH,
Ruth Berkowitz, IBCLC; ABA Breastfeeding Counsellor
Autralia
Date: Fri, 1 Jun 2018 17:43:13 +0000
From: Eleanor Molloy
Subject: Oral aversion (plus additional stuff)
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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