nursing a babe with a high palate and weak suck

[mamamelia]

has anyone done this? any links on how to? i googled and couldn't find much. i'm carrying dd right now and need to keep moving and can't give the full story atm. she is exclusively bottle fed and i want to get her back onto the breast. she is 8.5wo.

[mamamelia]

the first part:
dd1 has never "emptied" the breast after nursing. she would sit there for a while, but it didn't feel like anything was happening if that makes sense. during nursing, i would be able to easily unlatch her too.. almost too easily. it never hurt to nurse though and her latch looked perfect from the outside.
during her first night she was super fussy, and i chalked it up to being mucousy and well, just being a newborn! when we came home, i noticed that each time after being on the breast, the fussyness would start up again and she wouldn't sleep afterwards. i had no idea on what was going on.

now onto the second part:
i've always had difficulty with nursing on my left breast (from my days with dd1) and so it was no surprise when i tried to latch dd2 onto the left breast and failed miserably. the thought of tandem nursing for 2 years off one breast made me cringe, and so in an effort to "distribute" the milk more evenly, and keep my body producing milk from both breasts, i decided to pump the left breast and save it to bottle feed her every now when breastfeeding was fully established. i would nurse from the right breast. i couldn't bottle feed EBM to the nursling because she doesn't know how to take a bottle at all and just bites the teat, and she won't take the milk in a cup - she is not after the milk and is just a comfort nurser. so i decided that the babe will have the extra milk which will take the load off when i nurse both from the one side.
anyway, at 7-8 days PP i developed a bad case of mastitis in my left breast, had a high 39-40 degree fever for two days straight. i was in a delerious state from having a high fever for so long, and in so much pain that at a stage i refused to pump because i couldn't bear the thought of it. i was sobbing uncontrollably from pain and despair. the mastitis started on a friday and i started antibiotics on sunday when a doctor came to visit me at home.

now back to the first part:
so anyway, each time she "finished" nursing, the fussyness would start up. on day 4 i decided i would offer her a bottle of EBM to see if the fussyness went down, and she took it straight away (i did not stick it in her mouth, just brushed the teat against her cheek and she latched on without hesistating). she finished 2oz and suddenly, the fussyness stopped and she was a calm and content baby. she then drifted off into sleep for 3 hours when she previously could not sleep more than 20-30 minutes. without a doubt she was hungry. but i couldn't understand why because she was on the breast with a latch that looked good from the outside (even though it felt like nothing on the inside) and i KNOW i was producing milk.
this pattern continued and she took in about 16oz from a bottle every 24 hours at this stage, EVEN while feeding on the breast on demand, in between the bottle. but thanks to the mastitis come day 8, i was only able to give her 6oz in the bottle instead of the 16, and so i thought about pumping the right breast too. i didn't want to, purely because i did not want her to get used to just being bottle fed, plus i'd have nothing to give her in between the pumping. so i didn't pump the right breast for that day, and gave her the 6oz i could get from the left breast.. and it was torture. she would cry and cry in between nursing and was unable to sleep again (and i kept nursing her on demand. it was always breast first then bottle). then came the time where i tried to latch her onto the breast and she refused and just kept crying and fussing at the breast. she would arch her back and stretch out while screaming like she was in pain. i couldn't bear to see her screaming so badly. so then i said stuff keeping her at the breast for "breastfeeding" sake, she NEEDS to eat and sleep. the poor thing guzzled the EBM down like crazy.

after that, i resorted to pumping both breasts full time to meet her needs and she was no longer interested in the breast. she ate, smiled and slept. there was *zero* fussyness.. she really was hungry afterall. i still had no idea why.
i offered her a paci for comfort but she didn't take it. i tried a few and none of them worked. when i tried my pinky she took to it straight away. she sucked my pinky so far back in her mouth it kind of freaked me out. so i decided to have a feel in her mouth and it felt awefully different to dd1 - it was arched. i should add that she only takes a long and flat teat on the bottle.

we stayed like this till she was 4 weeks old, when my supply started to drop from 22-24oz/24h to 16-18oz/24h from BOTH breasts combined. i went in desperation to the closest early childhood center that would take me in (it is an appointment only place and it was a few days before christmas and everyone was closing for the holidays. i couldn't get in touch with any professional other than my doctor who doesn't know much about latching/supply issues). the ECC let me come in after i pleaded my case over the phone.. the nurse said we could try the nipple shield because it's close to a bottle and different nursing positions etc. so i went in the very next morning and we put the shield on and this is what happened:
*we had to keep latching dd onto it. she would just slip off. i had to hold her head on and practically force her which was horrible.
*she hung around enough for the letdown which was good but then pulled off and started screaming her head off.
*she refused to latch on after that.
we tried 20 minutes later. she wouldn't latch and would just scream at the top of her lungs. even the nurse who was willing to try almost everything, told me to stop. she said the baby's cry was heartbreaking, and indeed it was. she gave me info on domperidone, but said i don't have a low supply issue and that it was just the pump not keeping my supply up. well DUH, i knew that, but my only option right now was to continue pumping and try to get her on the breast in the mean time, and at that moment i wasn't pumping enough to meet her needs and needed to supplement and i DON'T want to supplement with formula because she would spit it back up and was unsettled afterwards. she told me to go to the breastfeeding clinic in the new year (it was december 22nd at that time) and there was not much else they could do for us. i felt so freaking helpless i just cried (and i don't cry in front of anyone). then she had a feel in her mouth after i told her that i suspect her palate is higher than normal, and she confirmed and said yes it is a high palate.

i ran to my doc the next morning, and told him to prescribe domperidone to me, but the problem was, i couldn't remember what the exact name was.. and he had no idea about drugs that help lactation. he looked it up in his drug book and couldn't find anything (it turns out in australia, domperidone is known as motilium). so he rang up the pharmacist that he consults and the pharmacist said that maxalon (which is reglan in the US) works just as well and prescribed that. i go to pick up the prescription and it turns out that people with a history of depression shouldn't take reglan and so the prescription was now useless to me. i have a history of high anxiety and almost-suicidal PPD and so it was a risk i wasn't willing to take. it was now dec 23 and everyone was closing down and my doc had closed, so no chance of getting another prescription. i got some fenugreek from the HFS and started on that. i needed to take 9000mg daily for anything to start happening, but it did happen and i was producing about 32-35oz/24h. unfortunately i also noticed it made dd super fussy and she wouldn't sleep again, and so i had to stop. now my supply is dropping again. soooooooo frustrating!!!! the milk is there, sitting in the breast, but my breasts are no longer responding to the pump like they used to. the pump is fine, the parts are fine... my breasts are just in a world of thier own.
then i said to hell with it all... i am going to put her onto the breast no matter what. and so last night while she was half asleep, i managed to get her to latch on.. it was such a bad latch, she was trying to drag the breast in the way she does with the bottle and it wasn't working. BUT, she was fantastic and hung around for the letdown. she would then do the back arching i-don't-think-i-can-take-another-breath scream and i would need to top her up with a bottle of EBM. she will only take the breast once per session and when it's over, it's over - there is no coercing her back to it (i tried different positions and nursing while walking). even though she is still hungry, she will not go back to the breast and will keep crying till the bottle comes. since last night, i have managed to get her on about 12 times. it's now 11pm. she is still *a little* fussy after being on the breast (even after having the bottle) which is upsetting as its almost like nursing makes her angry instead of calming her down!!!! : and i feel like such a failure when she sits there screaming at me. i already feel like a failure for not being able to produce enough milk for her naturally and well, the screaming just tops it.

i am going to the breastfeeding clinic on monday to see a good LC (the only time i can go as dh needs to take me). what do i do from now till then? continue as is? i'm scared of doing something wrong and getting her into a bad habit and confusing her even further. i really want to make this work. i am determined to get her back onto the breast, no matter what. she needs it, and since she does have a high palate, her jaw will be slightly comprimised and i don't want to do her a disservice with bottle feeding where jaw development is concerned.
i must stress that she still needs to be supplemented with the bottle shortly after going onto the breast otherwise she is inconsolable, so going bottle free is not an option because i know she is still not getting enough milk from the breast alone due to her latch and only hanging around for a minute max. she doesn't like the nipple shield.. she finds it harder than the breast (i think because it is short and she can't suck it back in much). so everytime she latches on, i hold the nipple in her mouth and keep it there till she spits it out. any advice as to how i should feed and pump? right now the routine is as soon as she wakes up, i will put her to the breast and wait for her to pull off, she will often cry shortly afterwards and i will try the breast again, fail and then top up with a bottle of EBM. i can't think of anything else that i can do...... any ideas??

TIA...

[CathMac]

I have no BTDT for you. I'm hoping someone else with experience in that area will come along. But I do have some Kellymom links for you on the topic and a link to a thread on a similar topic.

http://www.kellymom.com/newman/26bab..._to_latch.html
http://www.kellymom.com/newman/15bre...mpression.html
http://www.kellymom.com/babyconcerns/reflux.html
http://www.kellymom.com/newman/04enough_milk.html

http://www.mothering.com/discussions...ck#post7087740

Good luck, ~Cath

[mamamelia]

thanks cath, i will check out those links tonight. my midwife suspected my dd might have reflux too because she always gulps and screams even hours after feeding. she has been crying alot today because she has been on the breast alot... and then she spits up. :

[chiro_kristin]

Have you tried taking her to a pediatric chiropractor and/or craniosacral therapist?

[LinzluvsGJ]

My 2nd daughter was born with a very high palate and couldn't latch at all on the breast or even a bottle for the entire first week of her life (never did figure out a bottle so she never had one!). I helped her to figure out a stronger suck and develop those muscles in her mouth to work a little easier by finger feeding using an SNS. I taped the SNS to my index finger and fed her that way for every feeding. When it came to supply, once she started nursing I developed an oversupply- my guess is that it was my body's way of trying to help her out to make it easier for her to extract the milk.

:bighug: I hope you find something that helps!

[JaneS]

Antibiotics will effect her gut flora ... and therefore her immune system. Reflux is usually caused by gut flora problems as well and can certainly be caused by antibiotics and formula supplements. I would start bifidus probiotics on her right away. Natren Life Start or Solaray BabyLife. More info here: http://www.mothering.com/discussions...d.php?t=434071

Regarding PPD, please read Gale Force's posts here at MDC and seek out her website for more info. Both PPD and a high palate have been linked to nutritional deficiencies.

More info on palate later on down the road here:
http://www.westonaprice.org/healthis...velopment.html

[twinsarefun]

You are absolutely right about the high pallate! You have milk like you said and not a low supply. The baby is the one who is causing the problems with the supply. I have been going through this with my twins. I nursed two previous babies for almost three years with no problems and then I had my twins. I was so engorged I could have fed quads! I couldn't figure out why my babies were not gaining and I kept getting more and more engorged! The babies were not taking the nipple far in enough to stimulate my supply. I went to a specialist when my babies were 6 mo. She said that the babies had a high pallate. She didn't show me how to teach the babies to suck train such as the other gal mentioned. If I had known that, my babies would be straight bf today! Instead they are hooked on the SNS by bf with the tube always attached to the breast. It wasn't until my babies were 10 mo. that I found a top notched IBCLC who is widely known as the best. She confirmed a high pallate and said that the suck training exercises would have helped. I was to pump 12 x's daily with one pump at night, to get my supply back up. Also, put my finger in the babies mouth and let them suckle on it to get them used to having the finger past the bubble pallate. This has been hard though with babies that have teeth! Your baby is younger, so it will be easier for you. Only use a hospital grade pump. The others will be a waste of time. There is a specialist in the San Francisco area who will telephone consult. She is very helpful with women who have bubble pallates. Let me know if you are interested and I will give you her number. I would try and nurse first, then supplement at the breast using a SNS or peridontal syringe. Then pump to stimulate the supply. Do finger exercises by putting the finger in past the high pallate so baby will get used to nursing with the nipple past the bubble. You can do this with the SNS attached to the finger or without. If you supplement with the SNS, make sure you have the double tubed SNS so that baby will nurse equally on both sides to stimulate both breasts. I hope this helps. Ask away anything else you need! Let us know how you are doing. I'm glad that you are getting help now. If I had a good IBCLC in the beginning, this whole thing for me could have been over. The good news for you is that your baby is still very young and has a good chance of getting back on track. If you do end up using the SNS to supplement, make sure you don't put the tube 1/4 inch past the nipple like the directions say. It will only get baby used to nursing only with it. Start with the larger tube to interest baby and then work your way down to the medium and then smallest tubes. Make the formula in the blender with a little extra water so that the tubes do not get clogged. Make sure you put water through the tubes after each feed so they don't get clogged. Always try and nurse first without the SNS if possible.