Breastfeeding/Lactation Consultant

I think it is significant that your baby has not really reached her due date yet...........more

Congratulations on doing such a fantastic job providing breast milk under such trying circumstances. I hope you are using a rental pump with double kit, that can certainly make the pumping easier and more effective.

It may be helpful to do some suck training especially since the baby had a restrictive frenulum. Ask your LC to show you how to do this. In the meantime here is a description. Take your finger pad side up and stroke the baby's lips from nose to chin. When she opens wide allow her to take the finger in with the nail down toward the tongue. Allow your finger to fit into the roof of her mouth. As she sucks push down with moderate pressure with your finger and pull slightly foward. Repeat this motion as long as the baby is tolerating it. Your finger will move in sort of a small oval, down, front, up, back, and repeat. Try this prior to latching.

Also, as a tongue exercise, see if you can get your baby to stick out her tongue. Do this when she is not hungry or tired and is awake. Hold her in your lap facing you. Open your mouth wide and stick out your tongue, hold for a few seconds then close your mouth as you stroke her lips from nose toward chin with your finger. If she opens wide tap the tip of her tongue with your finger, this should cause her to stick her tongue out. Verbally praise her for opening wide and sticking her tongue out.

Also, here's a post on how to latch a preemie using a technique of areolar compression. This post also discusses the use of nipple shields for preemies, again ask your LC to work with you on these techniques:

http://boards2.parentsplace.com/messages/get/ppbreastfeeding251/23/1.html

If you get the baby latched you can encourage a better suck by doing some breast compressions when she stops or slows down. If she is actively sucking let her take pauses up to 10 to 20 seconds. If the pause lasts longer, take your whole hand and compress the breast and hold for a moment then release, pause, and compress and release again. Do this several times or until you get the baby sucking again. If this doesn't work to effect a good suck you can also try to stroke under the baby's chin toward the adam's apple to encourage her to use the tongue correctly. Apply moderate pressure when doing this. Some moms need to do this thru most of the feeding initially when a baby has had suck problems as a way to teach them to suck effectively moving their tongue from the front of their mouth to the back.

Once the baby starts taking the breast more effectively don't drop the supplements of breast milk abruptly. I find the best way is to reduce gradually as in this post...skip to about the fifth paragraph and of course this applies to reducing ebm as well as formula.

http://boards2.parentsplace.com/messages/get/ppbreastfeeding174/17.html

I probably wouldn't switch bottle types at this point. One is not better than the others but when you get a better more consistant latch you may want to supplement with an SNS if the LC thinks that would work and then you can reduce the supplements slowly from that. The SNS is a device that allows the baby to receive supplement while bf thru a fine tube attached to the breast with tape. It encourages the baby to take the breast for all feedings while insuring that the baby will get the supplement needed until she is able to bf effectively on her own.

Get back with follow up questions and updates. Hang in there it is still early yet to expect her to bf really well after all she has been thru.

Warmly Kathy

No experience with tongue tied, but I do have a preemie(m)

Good luck

Kristen

Looks to me like all other posts were answered, if I missed any I apologize, please post. Thanks. (nt)

Nancy (horsesjapan) ~ thank you for your response on board 521 RE: oversupply. Very appreciated! ~nt