Andrea Tran wrote:
> ....  He only poops about once a day, but has lots of wet diapers.
> Mom felt like her milk supply had gone way down - she had been under a lot
of stress > Weight was 8#4oz on 4/11 (1oz in 2 days -
> but different scales).> ....  the nipple has a compression strip across
about half to 3/4 of the end.
> Baby also has a notch at the end of his tongue, it looks slightly off
> center, but frenulum looks fine.  I checked his suck and he didn't want >
to suck on my finger at first, but he eventually did, but never really >
established a good rhythmic suck on my finger.  He didn't cup deeply,> but
it felt like a pretty strong suck.

Andrea, I wonder about the tongue function, as sometimes babies with a notch
at the tongue tip and whose frenulum looks okay (visually) have a deficit in
tongue function.  A couple of years ago I saw a baby girl whose tongue could
point and poke, and *looked* okay.  She realy tricked me, at first, but
after going through everything else, I decided to go back to examining the
tongue *function*, using Alison Hazelbaker's checklist.  Other factors that
brought me back to the tongue were faltering weight gain after the early
weeks (the baby was by then about 3 1/2 months), with the baby's hydration
only borderline, nipple pain and (from memory) a history of mastitis.  What
I found was that the tongue, though it could be brought forward, would
hardly lift at all - there was therefore this big space between tongue and
palate and the tongue wasn't rising to compress the breast tissue to 'milk'
it.  (I'm probably not wording this very well, but hope this is clear
enough.)
    The parents read the material I gave them and made an appointment with a
paediatric surgeon, who agreed with me and did the snip in his office.  By
then the baby was about 4 months, and was being supplemented by tube at
breast (homemade device).  There was an improvement at the feed immediagtely
after the procedure in the surgeon's office, but after that progress was
slow.  After all, the baby had a lot to relearn, after 4 months of
compensating for the restricted movement.  She was still breastfeeding some
months later, however.
     Now, no two babies are the same, but I would suggest at least checking
out the tongue function again.  Can the tongue elevate normally? During
suck, is the wave-like motion front-to-back or mid-tongue to front (a kind
of tongue thrust)?  You mentioned that the tongue didn't cup very firmly
round a finger. Can the baby move the tongue sideways to follow a finger?
If the baby isn't able to lift the tongue to make that rolling motion, or
wave-like motion, against the drawn-out areola, this can account for the low
gains.
     All those great ideas, like breast compression, will help to some
extent, but if there is an underlying problem such as this, it is unlikely
to get better when the baby's intake needs to increase.  Another mother I
worked with about the same time as the above baby, baby also about 4 months,
had a similar situation except the baby couldn't poke her tongue.  The
mother chose not to have a frenotomy done, preferring to work hard with
frequent feeding, careful attachment (still not necesarily painless),
galactogogues, and really battling constantly to maintain borderline weight
gains.  That was her choice, but it was an informed choice.
     I hope these ideas help.  The mother is lucky to have you there to
support her, Andrea.
      Virginia
       in Brisbane

             ***********************************************
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