Breast refusal with very youg baby

August 20, 2012

Ptp - Baby refusing breast - born on 7/5/12, 7 lb 5 0z (almost 50 percentile on

growth chart), most recent weight on 8/13/12 (5 1/2 weeks later) is 8 lb 9 oz

(almost 10th percentile). NICU for first four days due to constant grunting

(mom describes 'henh, henh, henh on exhale' - so difficulty breathing?);

grunting stops and they're sent home with no diagnosis for it. Baby has always

clicked during nursing, every feed, the whole feed. I felt and saw a lip tie,

not sure if I felt a PTT as he wanted my finger out at that point, palate was

not so very high/bubble-like, tongue did groove around my finger. Only actively

'nurses' while there is a let-down, no comfort nursing. Loves his paci - bottom

lip doesn't seal, mom often holds it in for him.

Tried football hold and he didn't click constantly for the first time and was

noisier (grunty) while nursing. He doesn't seem to know what to do when mom puts

him on to nurse and after the let-down stops flowing, again he gets confused -

she let's him suck her pinkie to regroup before he nurses again, this also is

happening now with the bottle.

For the last five days he's nursed very briefly, mom no longer feels random

letdowns although she can still pump 6 oz easily, today (Sunday) baby refuses

breast but does take the bottle, gets upset at breast.

So, frenulum/s are making nursing difficult, possibly the architecture of mouth

and throat make it difficult to maintain suction at breast and paci, living on

mom's good supply and her let-downs. Mom instructed to: feed baby anyway he

prefers, pump to maintain production, skin-to-skin, nurse while baby is

sleeping, s-t-s during bottle feeds and try to 'finish at the breast'. We had

planned to meet again this week to improve latch and positioning, now we need to

woo him back to the breast. Tomorrow we'll weigh baby, feel under the tongue

again, suggest chiro/cranial sacral, ask mom to lose the paci or keep it in the

car. Nearest person able to revise is 3 hours away.

Would some tongue exercises help this bub?

Would a feeding tube be useful to keep him on the breast or should it not be

used to possibly reward a less than great latch?

What else should I look for or do?

Thank you for your input!

McCormick, IBCLC

Shelburne VT

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