As a NICU nurse, my infant feeding practice is based on my passion and clinical expertise to provide expert feeding care for all babies regardless of how they are fed.
Andrew’s feeding story is one example of how I provide solutions for mothers when they are desperate for infant feeding knowledge which includes more than breastfeeding.
“Where science, infant feeding and shame-free support rules.” ~The Momivist~
Andrew’s mother contacted me early in her 3rd pregnancy because of her long, complicated history of insufficient breast milk supply. Her goal was to be in a position of strength, to avoid going through another traumatic breastfeeding experience. I was happy to help her and together WE created an infant feeding plan that was perfect for her.
She delivered Andrew at 37 weeks, and unfortunately he needed complex care in the NICU. We simply changed her feeding plan to include the NICU setting, which happens to be my specialty. Since Andrew could not be fed orally (because he was intubated), Elizabeth began to use her breast pump in hopes of producing colostrum for him. She was thrilled when she pumped enough to supply Andrew with his first oral feedings. Her supply didn’t last long as expected but for the first time she was supported without guilt and moved on knowing formula would nourish her baby. Elizabeth was over the moon with utter joy, despite the trauma of seeing her precious baby in the NICU. Finally, she was able to enjoy her new baby boy, in all of his glory, without the nagging thought of feeling like she was failing her baby again.
Andrew began having feeding problems at around 4-5 weeks of age; he began spitting up, then it turned into vomiting, during or after nearly every feeding. He would only ever drink about 2 ounces and then vomit. His weight began to drop and his pediatrician ordered tests to rule out pyloric stenosis – a blockage where his stomach enters his small intestine – but he had a normal x-ray result. He was then placed on Zantac, AR formula, and then oatmeal in his bottles to help with his constant vomiting. Elizabeth tried nearly every bottle system available for over 2 long months, spending hundreds of dollars, and had very poor results. The only bottle system that seemed to work for her was the Evenflo anatomical nipples with flared wings. Andrew was a very unhappy baby and was clearly stressed. The only way Elizabeth got any sleep was by resorting to unsafe sleeping practices, just to be able to gain relief from her exhaustion. Meanwhile, his weight continued to drop drastically. He dropped from the 90th percentile at birth to the 23rd percentile at his 4-month checkup.
She contacted me again out of desperation and after carefully putting all of the information together, I knew he needed to have an extensive oral exam to rule out oral anomalies. Since Elizabeth is not local to me, I watched Andrew’s infant feeding videos along with up-close pictures of his mouth and this was what I saw.
As an IBCLC, it is beyond our scope of practice to ever diagnose or refer without first talking with the baby’s pediatrician. Elizabeth was able to get a referral and an appointment the very next day with a pediatric ENT physician.
Andrew was diagnosed with a tongue-tie and had a lingual frenotomy immediately.
(http://newborns.stanford.edu/Frenotomy.html). Within a few days, Andrew was eating better and his vomiting gradually decreased. At 3 weeks post frenotomy, Andrew was finally catching up with his developmental delays from lack of nutritional intake. He began to sleep longer and began smiling and holding his little head up for the first time.
His weight gains gradually increased and at his 6-month check-up he was at 35th percentile; at his 9-month check-up he was over the 40th percentile!
Mothers who bottle feed need access to lactation consultants too. LC’s learn all about infant latch, suck and swallowing physiology. While tongue-ties are relatively uncommon they can affect bottle feeding just as they do breast feeding.
http://www.ncbi.nlm.nih.gov/pubmed/25238577
https://www.researchgate.net/publication/10706557_Ankyloglossia_Does_it_matter
The Momivist 