Hello wise colleagues,
  I am working with a mom and baby ptp and could use some guidance. Baby was born early October at 27 weeks.Went home end of january around due date. I first saw them in early Feb. Mom has huge supply, baby would go to breast briefly, but then go into refusal behavior. Baby is tongue-tied and also has grooved palate (probaby from tubiing, right). I explain that with those 2 situations baby is probably finding BFing difficult and tiring due to the challenges inherent in maintaining suction.OK to use NS a little longer, info. given on TT to think about having clip of tongue. I suggest mom tone down supply a bit too as she is pumping 1000-1400 ml/day and if she pumps closer to 800-1000/ day it might help baby at breast. She'll get back to me. A few intermittent calls over the 3 months. She was just about to start really getting serious about btb when the thrush started and she decided to wait. Baby did for a few weeks go to the breast during the night, but refuses during the
 day.Saw them again last week end of April, baby has been dealing with reflux, 2months of thrush. tongue is heart shaped on end, groove is a canal down the middle of the upper palate. Baby completely refusing to go near the breast. shared lots of ideas I have gleaned over the years on lactnet and elsewhere. She'll think about them. My questions: can anything be done about that palate. Will it change? Is it still part of the problem re keeping suction with a 13 # baby several months old, depending from what month you count. I think they have decided to have the tongue clipped now.
  Also she is fortifying her milk as is often done with premies for one year. 1/4 tsp /oz of breastmilk. She is looking for the studies on breastmilk storage (the 9 hours or one reheat info) and how would this be adjusted if there is the 1/4 tsp fortifying formula / oz. She is trying to come to terms with the baby never just going to the breast and I was trying to make it easier ie. breastmilk and getting out for a few hours. Would it be reasonable to not fortify here and there if it made everything work better for her overall.
  thanks all


Janet Dombro, RLC 
International Board Certified Lactation Consultant

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