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Thread: A combo of bf challenges.

  1. #1
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    Default A combo of bf challenges.

    Hi! I have a four week old little guy. He wasn't a preemie, but there were some complicatons with his birth and he spent the first eight days of his life in the NICU. I began breastfeeding him on the fifth day. He is tongue-tied, so the LC immediately gave me a nipple shield to use. It was a bit challenging to get him to latch after his experiences (he was on a ventilator and tube-fed), but we made a go of it. I have been EBF since then. His weight gain has been very poor, so - per the recommendation of an LC - I began pumping a week ago in addition to breastfeeding and giving him the extra I pump out - which isn't very much. I'm only able to give him an extra 3 oz or so every day. I just ordered some moringa with the hope of increasing my supply.

    When I was given the nipple shield, I knew nothing about it, so I went along with everything the LC said. I hate it for a multitude of reasons, but recently my little guy has begun sucking so hard that it's pulling my nipple through the holes in the shield - oh the pain! That's not what is supposed to happen, is it? Sometimes I am able to get him to latch without the shield, but his tongue-tie makes that just as painful. My nipple is always flattened when he detaches, no matter how hard I work on the latch.

    The doc in the NICU refused to clip his tongue, and I was fine with that because I had no idea how it would affect the breastfeeding. Now two different LC's have told me that we must get it clipped and I'm (almost desperately) looking for someone willing to clip it, but am finding it way more difficult than I imagined. We've been seeing a family practice doc for my son, and the doc seems extremely out of touch with infant care. He said we need to wait until he's older to have him clipped. I'm going to have my son switched to a pediatrician, but I have to wait until his paperwork goes through. Then - I hope - I can get a referral to an ENT clinic.

    In the meantime, I feel like I'm never able to give him enough to eat, and I'm never able to pump enough, and I'm frequently in excruciating pain. It's taking everything within me not to throw in the towel!

    If you made it through this whole post - thank you! Any thoughts would be welcome.

  2. #2
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    Default Re: A combo of bf challenges.

    Try feeding him without the shield. If his suck is strong enough to get your nipple THROUGH the shield, he may do fine without it. And give yourself a little time. Because honestly, with that one supplement of your milk a day your child is going to get an extra 21oz a week. Which is almost an entire extra days worth of milk a week. I am pretty sure that if you are consistent with that you should see a positive gain in as little as two weeks!

    Way too lazy for formula

  3. #3
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    Default Re: A combo of bf challenges.

    Well, the easiest question first-NO, your nipple should not be getting sucked in through the holes of your shield! I agree with djsmom, this may be an indication there is no need for the shield. Shields are not really supposed to be used for latch pain, although if it's working for that and it is the only way to keep nursing baby at the breast, then you will want to consider still using one. Maybe a different size or brand of shields will be a better fit. But shields are primarily helpful when a baby cannot latch without one.

    I also agree that 3 ounces 'extra' a day is great. Another way to look at it is as an entire additional feeding-a good sized feeding. is it enough for YOUR baby? That I do not know. Is baby gaining better now with that extra pumped milk?

    Are you still working with the IBCLC on latch and low production issues? Even if the tongue needs to be clipped, you may be able to improve latch somewhat with different positioning or latch techniques?

    It IS frustrating to not be able to get quick treatment of the tt, as it appears to me that tt or anyway, the painful latch is at the root of your difficulties. Unfortunately, this is a common situation. Have you tried educating your family doctor? The LCs did not have a doctor or dentist they could suggest to you?

  4. #4
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    Default Re: A combo of bf challenges.

    I would totally do away with the nipple shield. Even though he may have a poor latch at least he is latching strong enough to get you nipples through the shield (ouch by the way). I would say work on him at the breast without the sheild. I dealt with a lot of pain the first couple of weeks with sore bleeding nipples but you gotta just work through the pain and it will get better. It is almost as if your nipples have to toughen up. Mine did and now we are nursing great!! I feel for you!! good luck mama!!
    Happy Mama of 4 beautiful boys ages 14, 10, 7 and the newest member of the family:
    Damian Gabriel 2/13/13 , , twice a day at work, and finally successfully. We never gave up and we are as happy as can be !!

  5. #5
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    Default Re: A combo of bf challenges.

    Nipple getting sucked through the holes in the shield indicates that baby is actually capable of a fairly deep latch, and that at this point the shield is just getting in the way of a better latch.

    You may want to contact a pediatric dentist- sometimes they will deal with a tongue tie.

    Can you tell us a little more about the pain you're experiencing? Is it a pinching pain, or more of a burning? Does it happen in between feedings? Do you ever see the nipple skin blanch (turn white) or perhaps blanch and then turn purplish-blue before returning to a normal color?
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  6. #6
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    Default Re: A combo of bf challenges.

    Thank you! All of the replies are so helpful. It gives me a better perspective to realize that I'm giving him an extra day's feeding. I'm phasing out the shield. We've done most of our feedings today without it. There is much fussing and flailing as he tries to get latched, but it is getting better, it seems. And I do feel like he's getting more milk. I've heard him gulping at various points, which never happens with the shield.

    To answer some questions...
    Is baby gaining better now with that extra pumped milk? Yes. Last Thursday he finally reached his birth weight again (8lb, 12oz. His lowest weight was 7lb, 15.5oz). We'll have him weighed again on Wednesday.

    Are you still working with the IBCLC on latch and low production issues? Even if the tongue needs to be clipped, you may be able to improve latch somewhat with different positioning or latch techniques? Yes, but from afar. I live in a very small town and the closest IBCLC is two hours away. But I have a IBCLC that I can call at any time. So since we left the hospital all advice has been over the phone rather than in person. She has walked me through correct positioning and latching in great detail, and especially recommended the football hold, but I can't seem to get him to latch well no matter what. His TT is very tight and right up to the tip of his tongue, so it's impossible for him to push it out over his gum. I wonder if it's even possible to have a good latch?

    Have you tried educating your family doctor? I haven't tried, but I suppose I could.

    The LCs did not have a doctor or dentist they could suggest to you? I was referred to a couple different pediatricians and a pediadontist, but none of them will clip it. I truly don't understand what the hesitancy is.

    Can you tell us a little more about the pain you're experiencing? Is it a pinching pain, or more of a burning? Does it happen in between feedings? Do you ever see the nipple skin blanch (turn white) or perhaps blanch and then turn purplish-blue before returning to a normal color? The pain is a pinching pain. I have no pain between feedings other than general nipple sensitivity. When he's done feeding, it looks like the nipple has been pinched with a whiteish crease down the middle. I haven't noticed any purplish coloring.

    Thanks again!

  7. #7
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    Default Re: A combo of bf challenges.

    The hesitancy is that despite years of evidence to the contrary, doctors are still not taught that tt is a barrier to breastfeeding and consequently a serious medical issue that needs to be treated immediately or asap in newborns. They have never seen a release done at this age because they are taught it is not needed. ugh!

    Parents have gotten on planes and flown across the country to get tt treated. This may not be possible for you but am just saying it to stress how vital treatment can be. I just want to assure you you are not crazy-if a baby needs treatment for tt because it is interfering with breastfeeding, he should get it. Your baby deserves to be able to nurse effectively and be able to get your milk for as long as you wish, and you deserve to nurse comfortably! Frankly I think it should be malpractice to not treat a baby in such a case.
    I don't know what to tell you except to arm yourself with info and keep pushing for treatment. Meanwhile, keep working on latch and positoning to make nursing as comfortable as possible.

    articles on tongue tie and treatment http://kiddsteeth.com/articles.html

    http://www.brianpalmerdds.com/bfeed_frenulums.htm

    My favorite latch and positioning articles and tips

    Here are two simple pictorials, one on latch, one on tongue tie http://cwgenna.com/quickhelp.html

    general Tips on latch and positioning http://www.llli.org/faq/positioning.html

    Laid back position http://www.llli.org/docs/00000000000...astfeeding.pdf

    laid back video http://www.biologicalnurturing.com/video/bn3clip.html

    latch and 'Breast sandwich' article http://www.llli.org/llleaderweb/lv/lvfebmar04p3.html

  8. #8
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    Default Re: A combo of bf challenges.

    Quote Originally Posted by @llli*travelinglight View Post
    Can you tell us a little more about the pain you're experiencing? Is it a pinching pain, or more of a burning? Does it happen in between feedings? Do you ever see the nipple skin blanch (turn white) or perhaps blanch and then turn purplish-blue before returning to a normal color? The pain is a pinching pain. I have no pain between feedings other than general nipple sensitivity. When he's done feeding, it looks like the nipple has been pinched with a whiteish crease down the middle. I haven't noticed any purplish coloring.
    Thanks for adding those details. This definitely sounds like latch pain, probably related to the tongue tie, rather than something like thrush or vasospasms- and believe it or not, that's a good thing! Latch issues generally improve in time, as baby's mouth grows. A bigger mouth can take a bigger "bite" of breast.

    Has anyone suggested the "nipple sandwich" technique to you? That can help baby get a deeper latch.
    Coolest thing my big girl said recently: "How can you tell the world is moving when you are standing on it?"
    Coolest thing my little girl sang recently: "I love dat one-two pupples!"

  9. #9
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    Default Re: A combo of bf challenges.

    My little guy has been much less fussy today than he normally is. I attribute that to getting off the shield. Now, I suppose, he's getting more milk and not having to work as hard to get it. But my nipples! I read all of those links (thank you!), and have been trying to improve his latch, but he doesn't seem to have the reflex to tip back his head and open his mouth, no matter what I do or how long I wait for him to do so. I am seeing my midwife tomorrow, so hopefully she can help me. She offered to clip his tongue, but he would be her first baby to clip. I'm not sure I feel comfortable with him being the experimental one. What do you think?

    I talked to his current doctor's nurse and explained everything. She made me appt a week from now to get a referral to an ENT clinic. Once we get the referral I don't know how long it will take to get an appt at the ENT clinic. If we can't improve his latch I can't imagine that I'll still have nipples a week from now (perhaps that's a bit dramatic ), but it's better than nothing.

  10. #10
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    Default Re: A combo of bf challenges.

    Oops, duplicate post.
    Last edited by @llli*travelinglight; April 16th, 2013 at 11:22 AM. Reason: duplicate post

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