Yesterday, I worked with a 2-month old who won't open her mouth wide
enough for a deep latch.  Mother successfully breastfed two previous
children each for a year each.  This baby was given bottles in the
hospital and has been supplememented ever since.  In fact, baby has been
predominantly bottle fed.

Mom said she recently saw pediatrician, and nurse told her she needed to
decide if she was going to breastfeed or bottlefeed.  The nurse had
suggested breastfeeding at at least every other feeding (if I remember
correctly) and limiting bottlefeeds to 3 oz.  Mom really wants to
breastfeed, so she increased frequency of breastfeeds.  However, they
became so painful than she backed off.  She now has mastitis on the
underside of one breast.  I told her she would need to rent a hospital
grade electric pump and buy a supplementer before she came to see me,
and she did.  She has been using a continuous suction pump about 4 times
a day (E____) and releasing the suction about once a minute.

When I saw the couplet, infant refused to open her mouth while
positioned at breast in a football hold despite mother's milk dripping
into her mouth.  Mom said, "She is just waiting for me to put the nipple
(the bottle nipple) into her mouth."  Finally, the baby became
frustrated and began arching away.

Mom pumped 2 oz. while dad kept baby from going ballistic.  I taught the
parents to finger feed.  After a brief introduction to finger feeding,
baby willingly and patiently took the breast milk plus about half an
ounce of formula by finger feeding.  I discussed the treatment for
engorgement and mastitis, being sure dad heard the instructions that mom
MUST rest.  I told them that if they chose to give any feedings by
bottle (because I really do want mom to rest) that it would be best if
they use a bottle nipple with a long wide base and insist baby suck on
the base of the nipple, and also discussed making baby open before
putting finger or nipple into mouth.  Told them to stop the pacifier.

Saw no evidence of a rooting reflex.  Is it possible this baby no longer
has one?  (I see predominantly newborns.)  Any suggestions?  What are
the possibilities of achieving a deep latch with this baby?

Mom is to call me today and see me tomorrow.  I also told her to call
her doctor regarding the mastitis if it wasn't better today.

Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA