Friday, April 13, 2012

Lactation Consult/ Frenectomy

Last Friday Jack had his 2 Week appointment with his pediatrician. He had lost weight again. He was 7 pounds 3 ounces at birth, 6 pounds 7 ounces at his 1 week appointment, 6 pounds 10 ounces the next day at a follow up appointment to be sure he was getting some nutrition, and then 6 pounds and 7 ounces again at his 2 week appointment. This worried the pediatrician so she made an appointment with us later that day with a lactation consultant. I was excited for this appointment since I had wanted to meet with a lactation consultant anyways to get some tips on nursing.

We met with the consultant and she first examined Jackson. Immediately she said, "I see the problem!" I was curious since she hadn't even seen us nurse yet. She brought Matt and I over and showed up his tongue. He is tongue-tied, which means the membrane under his tongue is attached to the tip of his tongue as opposed to being further back on the underside of the tongue. This prevents him from being able to stick his tongue out of his mouth, which is necessary to nurse properly. (he also cannot lift his tongue very high inside his mouth and it might affect his speech later in life) The pediatrician had noticed this when she examined him at the hospital after he was born, but she said it shouldn't have any functional issues.

Here's a picture of Jack crying. You can see that his tongue stays at the bottom of his mouth instead of lifting towards the roof like most infants.
Here's a second picture that shows the tongue tie. The picture is a little blurry since he likes to shake his head back and forth while he cries. It's pretty adorable, actually! Matt thinks Jack looks like one of his Silent Hill monsters when he does that! Not sure I'm a fan of that comparison (Matt bought the Silent Hill HD collection when it came out so we've been reliving his favorite videogames)
And a third picture showing his tongue remaining at the base of his mouth. In a larger version you can see the tie clearly, but this picture uploaded small so it's difficult to see the small tie.
The lactation consultant observed us nursing and stated that Jack was not able to latch on and basically was just licking whatever happened to come out. No wonder he is losing weight! Poor baby wasn't getting much nutrition at all! She showed us how we can help him latch on with different positions, but it would still be difficult for him to nurse comfortably. She gave us a nipple shield to try which would help get the milk further back in his mouth/throat as opposed to just the front. She also gave us some syringes that we can fill with milk and place in the shield to encourage him to suck. This way he still gets the feel of nursing.

I have a Medela electric pump. The consultant suggested I attempt to nurse Jack, but also to pump each time. This way I will have milk for him at each feeding to ensure he is getting proper nutrition. She gave us new breast shields for the pump that fit my breasts better. The pumps come with one size that certainly does not fit all. In the manual that comes with the pump it even shows that size as being "small". These new shields make pumping much more comfortable, which will be nice once I return to work.

The consultant referred us to an Ear, Nose, and Throat Doctor. Our appointment with her was this morning. She examined Jack and saw the tie. She then performed a frenectomy. Essentially she clamped his membrane and then clipped the membrane. Simple and quick. She cauterized the wound and said it should heal within 4-5 days. Jack was taken out of the room while the procedure was completed. Thank the Lord because I don't know if I could have handled being in the room! There supposedly aren't any nerves in the membrane so he can't feel it being snipped, but baby's don't enjoy having things probing and stuck to their mouths! When the door to the room he was in opened we could hear him crying as he was brought back to us. When he came back in the room there were big tears running down his cheeks. Made my mommy-heart sob! As soon as he was in my arms and I coo-ed at him he calmed down. There's nothing to equal the feeling of calming your baby!

I immediately tried to nurse him to help soothe the wound. After a few failed attempts he was able to latch on and nurse! It was such a wonderful feeling! I could barely feel him nursing as opposed to before when nursing was pretty uncomfortable. I figured Jack and I were just getting used to the process. It's hard to explain, but I had a swell of emotion as I fed my child. I was so thankful I was able to feed him this way as opposed to having to use a bottle or other devices every time.

Here is a picture of Jack tonight with his un-tied tongue.
Here's a closer view. The cauterizing caused the bottom of his tongue and the portion of the membrane attached to the floor of his mouth to become a "silver" color. It makes it all look dead, but it keeps him from bleeding and will help him to heal faster. You can see how much higher he can lift him tongue now though.
We had begun sticking our tongues out at Jack when he looked at us. He would mimic us and stick his out as well! So much fun to see him learning already. We're going to let his tongue heal for a couple days and then try again. This should help him learn to stick his tongue out further to assist in nursing.

Once we arrived home, we continued to have difficulty nursing. He is drooling a lot, which I attribute to the healing process. This makes nursing super messy and he's been slipping off a lot. After he (and I) would get good and frustrated I would give him a bottle. Hopefully once his mouth heals more we'll both learn together to nurse. We also have a follow up appointment with the lactation consultant to ensure we're on track with feeding.

I am thankful we were able to get this resolved so quickly. While it does break my heart that Jack has been more fussy than normal since he's uncomfortable, I know this will help him in the long run.

He's been feeding every 2-3 hours all day and night. That makes for one tired mommy! Matt has been helping with feedings since we've been using bottles, but during the night I wake up with Jack each time so Matt can sleep the entire night. I am excited for his tummy to grow larger so he can eat more at one time and have fewer feedings. Each feeding takes between 5-10 minutes. After this he usually needs to snuggle a bit before he falls asleep enough for me to put him in his sleeper... sometimes he doesn't settle down so I sleep with him on my chest (my arms gets super cold since I keep my blankets around my waist and put a receiving blanket around Jack). By the time he settles down and I almost fall asleep... it's time for a feeding again! During the day it's the same story except I just don't have time to get much else done! Not complaining, but I feel bad when the dishes get piled up or the bills get left undone until the last minute.

Currently I'm sitting on the couch watching through the first season of LOST. Jackson fed about half an hour ago. He's lying froggy style on my chest and I'm using my arm and the boppy to hold him up. My laptop is resting on my knees and the boppy as I type. Oh the life of a young mother! I wouldn't trade it for anything!

Our little buddy is so perfect and I am so thankful for him. I was more frustrated than normal today since he was more fussy than normal... but all it took was him snuggled against my chest to make me know it was all worth while. Having a child makes you appreciate life so much more.

But all that is for another post. :-)