Here is an update from my earlier post:

Mom, dad and baby came to my office, (this is our first visit since baby was
3 months old and mom had a plugged duct).  This little girl is active and
happy and babbles appropriately for her age.  She  looked much chubbier than
her weight suggests, she turned one year old on June 17.  She weighs 20 lbs
and is 28 1/2 inches long.  She nurses well and will drink water from a
sippy cup.  She gags on anything she puts in her mouth.  She will usually
take one bite then start to gag and then she vomits.  When they tried very
thinned puréed foods she did the same.  She never vomits after nursing. 

I thought of a tight frenulum but this little girl was just too active and
happy to truly evaluate this today, but I did give them information
regarding a tight frenulum.  As a matter of fact we questioned that when she
was a newborn.  Mom had very sore nipples at the start but a change in
positioning really worked well.  Sometimes though I know that even tight
frenulum babies nurse well if mom's anatomy is accommodating so this could
be the case here.  At any rate they are aware of some of the things to look
for.  It is not obviously tight, like with a V but she would not play the
"stick out your tongue" game so I could not get a look at how well she
extends.  
(although she did giggle at me and my coworker extending ours)

 Mom and dad are not interested in stressing her, they say that she seems
like she wants food but when she tries she gags, wretches and then vomits
and this sets her feedings further back so they would like to have her
evaluated.  Given the information that they received from the occupational
therapist and the pediatrician, they felt they needed more assistance.  

I was able to give them a list of  pediatricians that their insurance will
cover.  I also gave them a list of occupational therapists and speech
therapists that work with us and are supportive of breastfeeding mothers.  

I also suggested that they try dissolving a children's vitamin with added
zinc and iron, like one of the chewable into her sippy cup of water.
Hopefully they will be able to get her to take that, they think she will,
she enjoys her water. 

I also suggested to mom that they try a play group with other toddlers her
age that are eating solids.

The mom and dad said they will call me on Monday after they talk with the
new pediatrician and they will let me know how that visit goes.  

Thanks to Dianne, Patricia, Nancy and Dr. Newman, and any others who
responded to my post. 

Pam Price IBCLC, CBE
Lactation Services Coordinator
Women's Health
Trident Health System
9330 Medical Plaza Drive
Charleston, S.C. 29406
(843) 824-5013 office
(843) 728-9640 pager

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