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Thread: Flat palate

  1. #1

    Default Flat palate

    Hi,
    Baby Zoe is 5 weeks old and we had some difficult breastfeeding start with a poor supply on my side. The supply is starting slowly to improve, but I had to top her up with some formula and I think she might actually prefer the speed of the bottle rather than my breasts. She starts to be fussy at the breasts after 8 min on one side, so I switch to the other breast but sane thing happen after roughly 8 min as well. I keep switching side but once she gets fussy, she is restless until I give up and give her the bottle. Although she gets fussy at the breast I can see that I still have more milk, by expressing manually. Saying that, I have to admit that expressing with the pump afterwards I only get 20 ml for 15-20min of expressing at both breasts.
    I went to our breastfeeding clinic today to get some advices. It seems that the latch is not so good, my nipple is not round as it should be after a few minutes of feeding. After a full feed, and a lot of trials (shield, change of postures...) the midwifes concluded that Zoe has a flat palate, so they advised me to position her seating against me, facing me to ensure the angle with her mouth is wider. I did that today twice, and although the first time Zoe swallowed quite well and deeply, the second time wasn't as good. I am not sure I had the posture as good and can't find any explanations on this posture on Internet (don't think it is an "official" one).

    Does any of you have some advice on the posture but also on how I could improve the latch with a flat palate?

    Thanks!
    Fanny

  2. #2
    Join Date
    May 2006
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    20,607

    Default Re: Flat palate

    Welcome, Fanny and congratulations on the new baby!

    Let's forget about how the latch looks for moment, and concentrate on how it feels. Are you in any sort of pain, either during or after nursing? And if you are, can you tell us exactly what you're experiencing?

    Second, can you explain how you came to the conclusion that you had and/or have low supply? Was there ever a problem with your baby's weight gain?

    Finally, how much formula are you using in a 24 hour period?

    I know I'm answering your questions with more questions, but before we get into positioning, latching, feeding frequency, and fussiness, I want to make sure we know how breastfeeding is going on the most basic levels.
    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!"

  3. #3

    Default Re: Flat palate

    Thanks mommal for taking the time to understand my problem.
    The baby lost just a little less than the 10% when we left the maternity after 5 days. At the check up done for the first visit of the midwife, 8 days after Zoe's birth, she gained only a bit of weight, less than the 30g per days. We checked her weight regularly after that at 10 and 13 days it was a bit irregular but in five days she took 110g, 22g per days. We were advised to give formula at that time, only 30ml after a feed when needed. That's when I started to take the motilium (I was already drinking tea, eating cookies).
    21 days after her birth I went to see a lactation specialist at our hospital, she advised me to top up with 60ml whenever needed, and 90ml at the last feed of the day. Zoe had put on weight (+390g in the past 8 days), but she was hungry after the feed.
    Today I give her 3*90ml per day, and we have around 5 feeds a day. I have tried to reduce the quantity of formula (60ml) but she seems hungry when I do so (crying just after we finish the bottle). She looks healthy and have a nice tummy, I guess this is what really matter, but I am a bit sad not being able to breastfeed her more.

    Related to the pain, I actually don't have any. I was in the first few days, hence I started to correct the position and it seemed to work as my nipples got healed.

    One more thing though, yesterday I saw that one of my breast (the one that was the fuller) was a bit red. I saw my GP and it looks like I have a mastitis. I am taking some antibiotics.

    The baby is getting fussy on both breasts. The first few minutes on each breast are fine, it is only after some time that she starts complaining. She complains and kicks with her foot and her arms, but sometimes she stays on the breast, sometimes she pull off and on until I offer the other breast, where she starts all over again (nice swallowing and then complaints).

  4. #4
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    May 2006
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    Default Re: Flat palate

    Okay, so at this point you're nursing just 5 times a day, correct? For such a young baby, that's very little nursing. Most newborns do best when they nurse at least 10-12 times per day, and many nurse more often than that. If it were me, I would immediately start to offer the breast at least 10 times a day- especially at night. With a baby who has had issues with weight gain, you do not want her sleeping long stretches at night. You want her to wake up and nurse, nurse, nurse- it!/ great for supply and excellent practice for her breastfeeding skills.

    I would also do something called "finish at the breast," in which you nurse, offer a small supplement (30-60 ml), and then out the baby back on the breast for unlimited suckling. When a baby gets a ton of bottles from very early on, she will often learn that she enjoys the fast flow and easy rewards of bottle-feeding, and will come to associate the feeling of being full and comfortable with the bottle. By putting her on the breast after supplementing, you can train her to associate the feeling of fullness, comfort, and happiness with being at the breast.

    If you're going to supplement, the best way to do so is to offer your own breastmilk. If you are pumping every supplement your baby consumes, then her intake and your supply are equal, and that will make it easier to transition to exclusive nursing. Most moms who are pumping need to pump at least 8 times a day to produce sufficient supplemental bottles. You want to use a good double electric pump with correctly sized shields. A hospital-grade rental pump would be ideal.

    When you supplement, you can use a bottle or you can supplement via cup, syringe, or at-the-breast supplementer (e.g. Medela Supplemental Nursing System or Lact-Aid). For many moms, the latter methods are preferable to bottles because they prevent the baby from getting attached to the bottle. If you do use a bottle, you want to do the following:
    - use slow-flow (newborn) nipples to prevent the baby from getting used to fast flow and easy rewards
    - pause the feeding frequently in order to keep the baby familiar with the occasional slowdowns that accompany nursing from the breast
    - when it's time to offer a bottle, make the experience as much like breastfeeding as possible: open your shirt and cuddle baby close to your bare chest. Tickle her lips with the bottle nipple until she opens WIDE, so she doesn't pick up sloppy latch habits from having a bottle nipple pushed into a half-open mouth. Pause the bottle feeding at least once and switch baby to the other side, as you would switch her from breast to breast while nursing.

    How are you doing with the mastitis at this point?
    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!"

  5. #5

    Default Re: Flat palate

    The mastitis is getting better, my breast is not red anymore and It only hurts when I carry the baby on that side or sleep on that side.

    I find it really difficult to express more than twice a day when I am alone as Zoe does mostly cat naps and only one (two when in good days) long nap. I only have a single electric pump, from a good brand but I still need to be alone, not carrying the baby. Plus I always feel that if I express too much, I won't have anything to give her for the next feed. Any advice?
    I fully understand what you're saying about associating the fullness feeling to the breast and will do as you recommend. But in relation to feeding her more frequently I have some questions. As she gets fussy on the breast after some time, she clearly shows she is hungry, how should I deal with that? If I let her suck as much as she wants, she will be most of the time at the breast hence how to express? The first 10 days I breastfed her nearly continuously, trying to express whenever I could, and I found it exhausting physically and nervously.
    What position would you recommend? Natural nurturing, side lying...?
    Thanks

  6. #6
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    Default Re: Flat palate

    If you pump right before your daughter nurses, you'll still have milk. Milk is being made all the time, and the emptier the breast is, the faster the body labors to replace what has been taken. So if you pump and then the baby needs to nurse, she will still get milk provided that she nurses well. But ideally you want to set a pumping routine where you pump right after your baby finishes nursing. That way you give yourself extra stimulation AND plenty of time for more milk to be produced before the baby's next feeding.

    Now, if you simply nurse constantly and skip the pumping, it's possible that your baby's constant nursing will build supply to where it needs to be. Nursing is generally better for supply than pumping with even the best pump- and you don't have a very good pump (I hope you can change that!). But you're supplementing with a fair amount of formula, and I think the conservative route would be to drop the supplements a bit at a time while increasing nursing frequency and pumping whenever possible. So instead of doing a 90 ml supplement, offer a 75 ml supplement, nurse as much as possible, give it a few days, and then drop down to a 60 ml supplement.

    When it comes to positioning, you should do what feels most comfortable for you.

    Is professional hands-on help from an IBCLC a possibility for you?
    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!"

  7. #7

    Default Re: Flat palate

    I've been able to express four times today, one while she was playing next to me... Only 5minutes but it still counts right?
    I express a bit more, around 30ml for 20min, hopefully this is a good sign, although I know this is still nothing, but I need to be rewarded, and even small wins are good to have.
    Thanks for your advices and support, I really appreciate that!
    I have seen a lactation specialist at my hospital but I don't feel she will really help me to go back to exclusive breastfeeding... But I have seek help from Tresillian, an health organisation in Australia, a nurse will come end of the month, and hopefully give me some good advices and she will also observe what I am doing for feeding and sleeping routines. I hope she will help!

  8. #8
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    Default Re: Flat palate

    When it comes to pumping, every little bit helps. 5 minutes here and there is far better than nothing!

    How often are you nursing now?

    Is there a La Leche League in your area? LLL leaders provide free and often timely help. LLL in New Zealand and Australia: http://www.lalecheleague.org.nz/local-groups/australia

    I also found this: https://www.breastfeeding.asn.au/breastfeeding-helpline
    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

    Default Re: Flat palate

    I did three this night only. But she didn't sleep well, was only at peace when in my arm, feeding or sleeping. She is gassier and hasn't had a poo since Sunday evening.
    I gave her 80 ml this morning of my milk. And she hasn't left my breast, although she regularly falls asleep.

  10. #10
    Join Date
    May 2006
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    Default Re: Flat palate

    Keep at it, mama! And keep a close eye on diaper output. She's old enough that she may not poop every day, especially since she's eating some formula, which is notorious for making babies constipated. But you want her pee output to stay normal over the course of a 24 hour period, and for the urine to be pale and mild-smelling.
    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!"

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