Initial Pediatric Breastfeeding Report

Dear Dr. Sarah Jenkins,

Re: Leo Alexander Vance

I had the opportunity to meet with Leo and Maya and David Vance for a breastfeeding consultation on 14/05/2024. Weight in a clean, dry diaper was 7 lb 2 oz. Milk transfer at the breast was approximately 1.2 oz.

Leo's parents have raised concerns about painful latch and prolonged feeding times. The family has reported maternal bilateral nipple trauma, clicking sounds during feeds, and infant frustration at the breast. I suspect suboptimal milk transfer secondary to ankyloglossia and a shallow latch based on intraoral exam revealing a Coryllos Type 2 anterior lingual frenulum restricting tongue elevation and peristalsis, alongside blanched maternal nipples post-feed.

A comprehensive care plan has been developed, with the following recommendations:

• Utilize asymmetric latch technique in the cross-cradle position to facilitate deeper breast tissue intake.
• Triple feeding protocol: breastfeed 15 mins per side, followed by 1.0 oz expressed breast milk (EBM) via paced bottle feeding, then pump 15 mins bilateral q3h.
• Apply lanolin (Lansinoh®) topically to nipples PRN after feeds for moisture barrier protection.
• Referral placed to Pediatric ENT for formal frenotomy evaluation.

Parents are encouraged to contact us with questions, and follow-up is scheduled for 21/05/2024

Please contact us with any questions. Our telephone number is (312) 555-0184 and our fax number is (312) 555-0185

Thank you,

Dr. Elena Rostova