Hi All,
 I have permission to post...

I have been working with a mom for 4 wks now.  Saw her initially before baby
was born to discuss BF, positioning, etc - she had had serious issues with
baby #1 including hypoxic brain injury (severe) with baby due to sudden
unexplained seizures during labor (eclampsia) and then severe abscess in
left breast that ruptured and - well, what a mess.  Baby #1 never breastfed
and she weaned from pumping at 3 mo from the stress of her situation.  Baby
#2 born by planned c-section at 39 wks - big healthy baby 8' 14".  DOB
5-10-05.   Bf started off well - or so we thought.  Was pooping and peeing -
but at the lowest accepted amounts.  At 6 days of age, (5-16-05) when I saw
mom for 2nd time, baby weighed 8' 9" and looked fine.  BF appeared to going
well - intake wasn't great at breast, but I chalked that up to a sleepy baby
who had been fed an hour before I got there (they forgot to call and switch
times...).  Corrected the latch and positioning a bit and gave all the
standard instructions of what to watch for, etc...call me in a couple days
to keep me updated.  I wanted to keep a close eye on them given the fact
that we did not know how much milk she could produce on the left breast (due
to injury of abscess) and just given her history with baby #1.  They didn't
call...I left a couple of messages to check in - no call back from mom.

Mom calls me on 5-29-05 in a panic.  Baby lost weight - down to 7' 11" - Now
on ABM supplement, and mom is pumping like crazy.  Milk supply nearly gone.
Milk supply came back up within a week, baby gained weight like crazy - mom
now talking about getting baby back on breast.  I see them on 6-10-05.  Mom
has positioning and latch just fine.  Baby goes to breast, gets very fussy
within a few minutes.  Mom is doing compressions, milk is there...Again, mom
has large nipples (using the 30mm shield with Medela kit), however, baby is
getting a deep latch.  We try him with and without a nipple shield (trying
anything at this point).  Baby got NOTHING from the breast.  Even when he
was doing active sucking - not just the fast little choppy sucks to get
things going - he got nothing.  I did a suck evaluation with EBM in a
p-syringe.  Here is where I need your help:

Baby's palate is wonderful - but it just keeps on going...I never did quite
reach the juncture of the soft and hard palates.  When baby open his mouth,
the tongue looks like it is flat, but it touches the hard palate all the way
at the back - even when he sticks his tongue out.  I have never had my
finger in a baby's mouth up to or past my 2nd knuckle while doing a suck
exam - I was completely up to my 2nd knuckle and then some...by the time I
thought I felt that juncture the baby's gag reflex finally kicked in a
bit...this baby has the longest hard palate I have ever felt!  My
interpretation of this situation is that when he latches on to mom, the
tongue and hard palate compress the nipple and do not allow milk flow - the
nipple never gets back to the soft palate...He can take the avent bottle and
does fine so he can eat- just not from mom.  While doing the suck eval, he
did have some issues swallowing the milk when my finger was back where it
should be (in the avg baby)- when I let my finger go back as far as he would
take it (and still not feel that juncture) he had difficulties swallowing
the milk - his tongue wasn't really bunching up - but it was touching that
palate in back - and when I brought my finger way forward (as if it were a
bottle nip) he could swallow the milk, but I noticed that it pooled in the
back first.  I believe that he has managed to fix his issue in his own way
so that he can eat.

So, has anyone out there ever seen or felt anything like this?  If so, how
do you fix it so baby can breastfeed?  I don't mean fix the palate - but how
do you fix the BF?  Mom has already decided to wean if she cannot BF this
baby directly.  Too much stress for her to pump, feed baby, and take care of
her other child - who is 24 hr care.  Help??

Jaye Simpson, IBCLC
Out of my league on this one...

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