Tiny newborn too sleepy...small mouth

[@llli*koms1016]

My little DD came early today at 37.4 weeks. She is only 4.14lbs and is super small. She is very sleepy and little, so she doesn't nurse and when she does, her mouth is too small for my nipple. The left one came out looking like lipstick after she fed for a few minutes so not sure if that is okay. What do I do? Keep trying, use a shield, use a pump? We tried to tickle her and such but can't make her cold as her temp is already low. Appreciate any advice.

[@llli*maddieb]

Are you home or in the hospital? Is baby considered low birth weight?

If your baby was just born today, sleepiness could just be normal in a term or near term healthy infant. Anything past 37 weeks is generally considered term. However, your baby being so small, that is outside my area of knowledge, and I would suggest talking to/seeing a lactation consultant (IBCLC) if at all possible.

CAN baby nurse? Even if just on the nipple?

I suggest, Keep baby with you, skin to skin as much as you possibly can, and of course bring baby to the breast as much as baby will.

If baby cannot latch, or cannot latch and nurse effectively, I suggest hand expression. It is more effective in the very early days for many moms. You could hand express into a bowl and use a syringe to draw the colostrum up and give it to baby with the syringe. There will not be much! Drops. you can also pump as well, of course.

I am not sure a sheild will help-won't it make the nipple even bigger? However, it is certainly worth a try.

The left one came out looking like lipstick after she fed for a few minutes so not sure if that is okay.

Did it hurt? Was there any signs of swallowing? Again, this would be very subtle because the amount baby would normally be getting this early is very small. Sure the lipstick shape is a sign of a not ideal latch, but latch is often not ideal this early.

feeding the non-latching baby http://www.llli.org/docs/00000000000...ching_baby.pdf

Waking sleepy newborn http://www.llli.org/docs/00000000000...py_newborn.pdf

hand expression http://www.llli.org/docs/00000000000...expression.pdf

[@llli*koms1016]

We are still in the hospital. Yes she is considered low but all her vitals are good. I will keep trying to get her to suck. Latch didn't hurt much.

[@llli*maddieb]

OK are they letting you keep baby on your chest, skin to skin? That is what you want. If you are not comfortable with skin to skin, just have baby on you lightly dressed. they may be trying to swaddle baby but if they are, question that. Your body heat should keep baby warm enough. So no swaddling, if it can be avoided. You and baby under a light blanket should be enough. Lean back on the hospital bed in a comfortably reclined position-do not lean too far back, and not flat on your back, you do not want baby prone on her tummy. Just lean back comfortably, with baby snuggling into your chest.

[@llli*koms1016]

Yes I have been doing skin to skin all day. She sucked about 7-8 times 30 mins ago as she was rooting so guess that's good. My nipples are already bleeding a bit at the seam on the side since her latch is terrible now but I don't know how to fix it since her mouth is so small.

[@llli*maddieb]

Sometimes baby just has to grow a bit, and baby should grow quite quickly. Of course it is best if baby can nurse at the breast from the getgo, but if that is not possible, it's ok. Remember the 'rules' if baby cannot nurse- 1) feed the baby, 2) protect milk production, and 3) get help.

I wonder if there is anyone at the hospital that can help you? IS there an IBCLC on staff? A nurse who is particularly knowledgable? Do you have local LLL Leaders you can contact, local IBCLC you can see? you don't (or at least you should not) have to wait until you are out of the hospital to get help. Try to get help now.

[@llli*debbers]

I know this is stressful. My DD was born 37.5 weeks although bigger at 5lb 13oz but I struggled terribly with her tiny mouth and poor latch. Glad you are doing skin to skin, I did as well. Get as much help as you can from lactation staff. I only asked foe someone once and regretted that when we went home and I continued to struggle with latch. I was constantly doing look ups in 'the womanly art of breastfeeding' and consulting this forum. My nipples were so raw and sore and in between feedings I actually treated them with my own milk and let them air dry. I hardly had my boobs covered for 3 weeks. But here's the good news. She got bigger, her mouth opened wider and eventually it worked. It took time for sure. But I guess what is also good is that I can't even remember exactly how much time. Today she is a healthy 20 lbs - she will be 11 months at the end of the week - and we are nursing strong. She has never had a drop of formula and we do very little solids so that weight is all mommy milk!

Keep at it, keep doing skin to skin, keep asking for help from experts, make sure you coat your nipples with milk when you're not nursing and let them air dry and know that many moms have gotten through this, painful as it is. Also make sure you are hydrating - I drank coconut water (electrolyte replacement!) in the hospital, which my husband brought, and make sure you are eating well. He also brought me fresh fruit, nuts and avocado for good fats, even baked salmon once. The only hospital food I would eat is egg scrambles with veggies and no cheese. Giving birth is hard work and nursing is depleting.

[@llli*koms1016]

Thanks for the tips. I've gotten her to latch on my left breast everytime, although it does hurt. I doubt the latch is perfect, but the minute I take it off, she is asleep so I just deal with it to get her some food. The right one is being difficult. It is not flat but is slightly inverted and doesn't want to behave and perk up. It takes more effort for us to get a latch on that, but we are trying. She had 2 poops and 4 wet diapers and isn't even 24 hours old yet, so I'm assuming she's getting something from me right. We are trying to get a LC today, but none aren available on Sunday so it might be tomorrow. I have been using nipple cream and letting them air out to avoid any infection. Any other tips??

[@llli*sonogirl]

My daughter was born at 37.6 weeks--not quite as small in weight, but definitely tiny of mouth and extremely sleepy. I know that's term, but she honestly didn't seem quite "ready," if that makes sense, and I had a terribly complicated labor, so I felt kind of like I had a preemie! I was lucky that she cued very frequently, but oh, my nipples were a mess for the first couple of weeks. I also had to practically beg to see the LC, because I was considered low priority since baby was eating and putting out more than the minimum. But I really just wanted my latch checked, and that is truly an important concern!

So, in my case, it was just a wait to grow into a bigger mouth thing, but definitely push to see that LC to make sure that's the case for you. What helped me in the beginning was lanolin (my breasts don't respond well to hand expressing, so I could never consistently let milk/colostrum air dry on them) and keeping them uncovered as much as possible. And after a couple of weeks, her mouth was bigger, and everything resolved itself.

[@llli*debbers]

Thanks for the tips. I've gotten her to latch on my left breast everytime, although it does hurt. I doubt the latch is perfect, but the minute I take it off, she is asleep so I just deal with it to get her some food. The right one is being difficult. It is not flat but is slightly inverted and doesn't want to behave and perk up. It takes more effort for us to get a latch on that, but we are trying. She had 2 poops and 4 wet diapers and isn't even 24 hours old yet, so I'm assuming she's getting something from me right. We are trying to get a LC today, but none aren available on Sunday so it might be tomorrow. I have been using nipple cream and letting them air out to avoid any infection. Any other tips??

Just to try your own milk as a balm vs the cream so you don't have to think about your baby ingesting it.