TT, High palate, 3 months in, tandem nursing, forceful letdown.....help!

[ILovePie]

I'll lay out the challenges, and then what we've done...

DS2 had posterior TT and high palate.  3.5 weeks he had it clipped under general.  Not completely clipped, so we drove 4+ hours to re-do it with him awake.

Still clicking, losing nipple, compressing.

DS1 is still nursing - often- so I have a very plentiful supply.  Baby's weight gain is above expectations - no worries there.

I've had subacute mastitis and, I think, thrush.  Right now I'm eating garlic, taking GSE and probiotics baby and I are getting vinegar rinses every diaper change.

My nipples hurt and I'm contemplating weaning DS1 and moving to pumping for DS2.

We've done CST.  DS2 currently sees a PT 2x/week for myo-fascial release (tight jaw and lower lip).

We've seen a chiropractor.

Any other thoughts or suggestions?

[ShwarmaQueen]

I took DS to a speech pathologist, who does OPT, and she evaluated him for his extensive oral motor weaknesses and gave me specific exercises to do based on his areas of need. It was reassuring to know that there was a reason he was still clicking and gagging with the 'correct' latch, because he didn't have the strength to hold the position! Thanks goodness you have your older son to keep your supply up or else you might end up pumping/taking supplements/jumping through hoops like me.

I would make a plan to get rid of the thrush. The pain from nursing will improve a little over time, BUT 'they' say that it will help pull down the palate, the longer the better- a benefit bottles can't give. 

[ILovePie]

What is OPT?  I took him to a speech therapist who specializes in feeding issues, and no one has said there's any weakness.  The ST sent me to the PT because DS's jaw and lower lip are tight.

[ShwarmaQueen]

Originally Posted by ILovePie 

What is OPT?  I took him to a speech therapist who specializes in feeding issues, and no one has said there's any weakness.  The ST sent me to the PT because DS's jaw and lower lip are tight.

Occupational Physical Therapy. The one I went to had extensive knowledge re breastfeeding and the necessary motor skills- we found her through a hospital based LC.

[CheriK]

Has baby been evaluated for lower labial (lip) tie?  This can affect his ability to maintain good suction and latch really deeply (the clicking makes me wonder. . .).  Upper labial may also be an issue, although there isn't consensus about how much of a difference a tight upper frenulum makes. 

I also wonder about oversupply, based on your comments about compressing, sore nipples, and high weight gain in a baby with a poor latch.  Is baby possibly compressing to slow flow?  Coming off the breast when you have a let-down?  Other signs of oversupply (http://www.llli.org/FAQ/oversupply.html)?  If this is an issue, working to resolve it will probably help significantly.

I agree that seeking a Occupational Therapist w/ lactation experience (not all have any!) is another good idea.  An OT can help you with finger exercises to help baby with correct latch.  There are finger exercises to help with tongue extension (some babies with frenulum issues need to learn new tongue positioning after clipping) and with bubble palates.  Quote from Lisa Marasco on Dr. Brian Palmer's website:  “A “bubble” palate is a high spot, often the size of a finger indentation, that has a back rim. It may extend width-wise from gum line to gum line (wide bubble), or be a smaller indentation in the middle. As you feel the infant palate, your finger will go up, come down the back side or “wall”, and then have to go “around and past” that wall to reach the juncture of the soft palate. Your pad-side up finger loses contact with some of the hard palate in order to reach the soft palate. Babies often gag when you go past the bubble because they are not comfortable with it, even though it is normal to draw the breast back to that juncture, usually about 1.25-1.5” deep. Babies with bubble palates tend to rearrange themselves on the breast into a shallow latch, and I use pacifying on a properly placed finger to help de-sensitize them to deeper placement, sneaking back slowly.”

Also, treating the thrush is important.  The steps you listed (garlic, GSE, probiotics, vinegar) are helpful but are unlikely to resolve already established thrush on their own.  Lots of resources for treatment on the LLLI website, kellymom.com, or Jack Newman's site.  Remember that all 3 of you (both nursings!) need to be treated simultaneously, which might mean hunting for a knowledgeable doc if you use prescription meds.  I'd actually think Newman's All Purpose Nipple Ointment would be a good choice if you have sore nipples from latch issues and from thrush, as it will treat both issues (http://www.nbci.ca/index.php?option=com_content&view=article&id=76:all-purpose-nipple-ointment-apno&catid=5:information&Itemid=17).

Good luck, Mama.  You're doing a great job.  It sounds like you've had a really rough postpartum with this new baby.  I think sometimes when we're nursing older children, we forget how hard and frustrating nursing a newborn can be.  It WILL get better, and your months/years of nursing when it's easy will overshadow the difficulties. 

[ShwarmaQueen]

DS had a super fast weight gain as well, but we figured out it was because he was nursing soo often, and would only get the letdown, then get exhausted and never past that...so he never got full, and never took a break. I mistaked his disorganized swallowing for oversupply and actually tried pumping off the foremilk, etc...it was chaos. Eventually though, it caught up though and my supply crashed (between 6-10wks he only gained an ounce). You really are lucky in that you have your older DS to keep up your supply! The pumping and herbs I had to take were so stressful!

[ILovePie]

My plan regarding the thrush is to see a former IBCLC nurse practitioner at the pedi's office - we're out of state right now.  We're all going to need something systemic/oral, I think.  I've used monostat and lotramin af and the baby's yeast diaper rash has come back.  Since he has a diaper rash and I have a vaginal yeast infection (Merry Christmas over here!), plus I'm pretty sure I have it on my nipples (they're itchy), I'm not even sure what would be the best course of treatment?

As for labial tie - the pediatric dentist checked for it when he did the second frenotomy.

I've got myself on B vitamins and vitamin D, and we're on vacation so I have a lot of help and DS1 has been sweet and fun and amazing.  I'm nervous about getting back home, having little help day-to-day, and still dealing with the nursing stuff and nipple pain, etc.  I've not been myself and I've got a call into a psychiatrist to start some antidepressants, per my counselor's recommendation.  I'm taking care of myself as best I can - getting out for runs 3 days a week, getting mostly decent sleep.  But the PT appointments twice a week, plus "regular" life appointments, plus struggling to get DS2 latched 50% of the time, plus DS1 sometimes nagging to nurse....it can get pretty overwhelming.

Don't get me wrong, I love these kiddos, and DS2 is (aside from the nursing challenges) as easy a baby as I can imagine (DS1 was NOT so easy - and we had nursing struggles, too, though not this long-term).  Thank goodness.  And thank goodness DH and I are not healing from birth trauma this time around.