A number of syndromic conditions have mid-line defects (clefts,
ankyloglossia, frenula abnormalities) associated with them. Both the
presence and absence of certain structures, or abnormal variations in their
size or location could contribute to feeding problems.
DeFelice, et al, Lancet 2001; 357:1500-1502 report that a lack of lingual
and labial frenula are associated with Ehlers-Danlos Syndrome and are "an
additional minor criteria for identifying newborns with Ehlers -Danlos
syndrome before the appearance of the hallmark features."
De Felice et al, J Peds 2000, 136:408-10, describe hypoplastic of absent
mandibular fenulum as a new predictive sign of infantile hypertrophic
pyloric stenosis.
Japanese ENTs have been publishing for years (see refs in Archives) about an
association between ankyloglossia and abnormalities in the throat that
contribute to breathing/apnea problems.
Receding chin is a possible indication of Pierre-Robin Syndrome.
All that being said, while it is interesting to read about such things, it
is the job of the physician to diagnose, and our job to understand how any
oral anomaly might affect feeding. If the lower jaw and tongue are too
short to 'reach' the breast, the baby is chewing air not milking the breast.
A baby with receding chin and short tongue might be really compromised in
its ability to create the positive pressure necessary to express milk. If
the tight upper and lower frenula are causing the lips to excessively
retract, this can impair seal at breast, compromising the ability to form
suction. Can you play tug-o-war with your finger or a pacifier and hear a
nice 'pop' when you pull out? Or do things just fall out of the baby's
mouth? A baby who can't create either positive or negative pressure is in a
world of hurt as far as feeding would be concerned.
Is the baby protecting the airways with that elevated tongue? Is a fast
flowing feed overwhelming and hence the defensiveness? Perhaps paced
feeding would be a place to start. I've seen underweight babies 'diagnosed'
with all sorts of feeding probs. who recovered nicely once they were fed up
to a stable weight.
Ability to beastfeed is, in my opinion, a diagnostic criteria. Everyone
should be interested in a baby who can't sustain normal feeding the normal
way. The LC assists the physician in such cases by DESCRIBING the feeding
prob. and making associations between oral structures and these
observations.
Everything is secondary, however, to rule # 1: Feed the baby. In this
case, find some safe way to deliver breast milk while working out what the
primary problem might be. And I wouldn't assume that a nipple shield would
break it or that finger training would fix it. You can't really blame a
shield for not working if it is inserted under the baby's tongue. Shield
use is a guided therapeutic intervention. The literature suggests that
weight gain is enhanced, not reduced, when the shield is used properly. I
can see how a small size (newborn small) shield with baby properly
latched -- perhaps with a feeding tube under the shield -- might be a dandy
intervention here. Even if baby couldn't make a great seal, it would be a
way to keep something happening at breast while you work out the other
issues.
Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
