Dashboard
Quick overview ~ updated March 25, 2026
Current Status
Active care plan
- Wean off nipple shields (started 3/25) ~ mid-feed switch technique
- Transition from triple feeding → exclusive breastfeeding
- Thompson Method positioning (cradle hold, 4-point facial symmetry)
- Lots of skin-to-skin and tummy time
- NOEL Method for daily routine
Care team
- Midwife: Home birth provider (uncomplicated, precipitous SVD)
- OT: Pediatric evaluation 3/24/2026
- Craniosacral therapist: Session completed (date TBD)
- Lactation consultants: Recommended triple feeding protocol
📅 Timeline
Key events
🍼 Feeding
Breastfeeding journey tracker
Current feeding plan
Goal: Transition from triple feeding → exclusive breastfeeding without nipple shields
- Triple feeding protocol (2-3x/day with finger/SNS + EBM/DBM for the rest)
- Nipple shields introduced 3/25 to help latch
- Weaning plan: try bare breast first at every feed, mid-feed switch technique
- Sleepy feeder ~ needs stimulation to maintain active suck
Breastfeeding challenges
- Inverted nipples (mom) ~ draw out with rolling/pump before feeds
- Sleepy feeder ~ falls into light sleep at breast, needs almost constant stimulation to hands, feet, cheeks
- Initial jaw clamping ~ bite reflex, improving with oral-motor warm-up exercises
- Tongue cupping ~ not quite creating suction initially, improves with facilitation
- Latch difficulty from Day 3 ~ preceded the weight loss
- Slightly high palate (per craniosacral) ~ treated with sphenoid lift
- R breast ~ some sore spots / possible early mastitis
- Using 16mm shields ~ working on weaning off
Oral-motor warm-up (OT prescribed)
Using your pinky, before every feed:
- Gum massage ~ inside lips, outside gums, gentle clockwise
- Resistive chewing ~ pinky on upper gum ridge, 5-7 reps
- Tongue tip ~ draw tongue forward with cupping
- NNS ~ empty nipple/finger, 5-7 reps to build rhythm before milk
Approach (Thompson Method + NOEL)
- Cradle hold, elbows down, hand on back NOT behind head
- Lips level with nipple (not nipple-to-nose)
- 4-point face-to-breast symmetry (chin, nose, both cheeks)
- Side-lying position for night feeds
- Lots of skin-to-skin between feeds
- No breastfeeding pillow ~ baby in crook of elbow
- Practice, patience, persistence ~ takes 6-12 weeks to establish
Weight tracking
Add weights here as you take them on the home scale
(Send Atlas new weights to add)
🎯 Breastfeeding Plan
Getting Eliana to exclusive breastfeeding ~ updated March 25
Where we are
- Supplementing with donor milk
- Using 16mm nipple shields to latch (started 3/25)
- Pumping to build supply
- Sleepy feeder needing oral-motor warm-up
- Mom has inverted nipples
- R breast sore spots (possible early mastitis)
Track 1: Ditch the Shield (Target: 1-2 weeks)
Every single feed, in this order:
- Try bare breast FIRST. Every time. Before shield comes out
- Prep nipple: Roll between fingers 30 sec, or 30 sec pump suction to evert
- Thompson positioning: Cradle hold, elbows down, lips level with nipple
- Give her 2-3 min to try. Let her bob and root
- If no latch: Do OT oral-motor warm-up, then try bare again
- Still no go: Shield on, start feeding, then mid-feed switch at 3-5 min
- If she refuses bare at that point, finish with shield. No stress. Try next feed
Best times for bare: Night feeds (sleepy = less fussy), after warm bath, during skin-to-skin sessions
Track 2: Build Supply (Target: 2-4 weeks)
Supply = demand. More stimulation = more milk.
Power Pumping ~ once daily, 5-7 days straight:
- Pump 20 min → rest 10 → pump 10 → rest 10 → pump 10
- One hour total. Mimics cluster feeding
- Morning is best (supply highest). Do for a week, break, repeat
After every breastfeed:
- Pump both sides 5-10 min (even if nothing comes out ~ stimulation is the signal)
Maximize hormones:
- Skin-to-skin multiple hours daily (Netflix + Ellie on bare chest = perfect)
- Don't skip 1-5am feeds/pumps (prolactin peak window)
- No gaps longer than 3 hours between breast or pump during the day
- 80-100oz water daily. +500 calories. Eat when hungry
Track 3: Reduce Supplements (Target: 3-6 weeks)
Build supply FIRST, then supplements become unnecessary.
Week 1-2 (now):
- Continue current supplementation. Focus on shield weaning + power pumping
- Track how much donor milk per day
Week 2-3:
- Replace donor milk with your own expressed milk first
- Reduce supplement 10-15% every few days IF: 6+ wet diapers, gaining weight, content after feeds
Week 3-4:
- Try some breast-only feeds (morning best ~ highest supply)
- Continue reducing supplements as supply climbs
Week 4-6:
- Most feeds breast-only, supplements 1-2x/day max
- Then once/day → as-needed → done
Weight checks every 2-3 days. If gaining → keep tapering. If stalls → slow down.
Right Breast (Possible Early Mastitis)
- Don't avoid it ~ drain it MORE, not less
- Feed R side first when Eliana is hungriest (strongest suck = best drainage)
- Massage sore spots toward nipple while she feeds
- Warm compress before feeds, cold after for pain
- ⚠️ If fever, red streaking, or flu symptoms → call provider immediately
📋 Daily Rhythm
Morning:
- Breastfeed (bare attempt → shield if needed → both sides)
- Pump 5-10 min after
- Power pump session (your daily hour)
- Skin-to-skin while she naps on you
Every 2-3 hours during the day:
- OT oral-motor warm-up
- Bare breast attempt → shield if needed
- Supplement if still hungry after both sides
- Pump 5-10 min after
- Tummy time during wake windows
Evening/Night:
- Cluster feeding is normal evenings ~ let her go to breast as much as she wants
- Co-sleeping / side-lying for night feeds
- Don't skip 1-5am feeds/pumps (prolactin peak)
📅 Expected Timeline
| When | What to expect |
|---|---|
| This week | Shield weaning in progress. Some bare feeds happening |
| Week 3-4 | Mostly bare breast. Pump output increasing noticeably |
| Week 5-6 | Supply catching up. Supplements reducing significantly. OT Goal 1 (mature suck pattern) |
| Week 6-8 | Approaching exclusive BF. Minimal supplements |
| Week 8-12 | Fully established. Breastfeeding feels easy and natural |
Every suck at the breast is a vote for more supply.
You're 16 days in. You have time.
Practice. Patience. Persistence. 💜
📋 OT Evaluation
March 24, 2026 · Day 15 · Age: 15 days
Reason for evaluation
Breastfeeding difficulties, history of slow weight gain (13% loss by Day 5). Parents requesting transition from triple feeding to breastfeeding.
State Regulation
Started session sleeping comfortably next to mother, loosely swaddled. Woke easily to quiet alert with emerging fussiness due to hunger. Calms easily with support or being picked up. Tolerates brief postural/mobility assessment. Calms with peri/intra-oral assessment. Briefly fussy with first couple of latch attempts, quieted with latch. Briefly active alert at breast but quickly fell into light sleep and requires almost constant stimulation to maintain active suck. Fell asleep and was re-alerted at breast several times over 30 minutes. Active alert with bottle supplements. Fell into deep sleep in side-lying with mother, mouth to breast but not latched.
Mobility / Neuromotor Development
Presents with primitive reflexes and neuromotor behavior expected for 2 week old term infant.
Supine (during diaper change, unswaddled): Smooth, random movement of all joints through all planes. Attempting global flexion patterns, then falling into gravity. Occasional self-triggering of Moro and spontaneous recovery. With support to proximal UEs providing hands to midline/mouth: spontaneous midline head orientation and enjoys pre-feeding activities/rooting toward hands.
Side-lying: Spontaneous primary physiological flexion. Hands to midline/mouth. Spontaneous pre-feeding activities/rooting toward hands.
Prone (tummy time): UEs supported in weight bearing, lifts head from surface 30 degrees, turns to either side, rooting toward hands, LEs moving between flexion and extension. Tolerates developmental mobility assessment VERY well!
Oral-Motor / Feeding Reflexes and Function
Presents with primitive/suck reflexes expected for her age.
Rooting: Small jaw excursion, tongue dropping from palate to floor of mouth behind bottom gum ridge initially, increasing ROM of jaw and tongue as stimulus (her hands) supported toward mouth, but not quite cupping tongue enough to create suction on her knuckle.
Lips: Top and bottom ROM within normal limits.
Jaw: Initially clamping/biting at stimulus. Emerging rhythmic (resistive) chewing (bite reflex). Strength/reps 6/10. ROM within normal limits after intervention.
Tongue: Lateralization with spontaneous cupping anterior to bottom gum ridge 3/3 bilaterally. Cupping anterior to bottom lip with facilitation of tongue tip.
Latch & Feed Assessment (Breast)
After intervention: Eliana easily demo sustained, rhythmic sucking with tongue tip stabilization on stimulus (gloved finger, Dr.B pacifier) allowing for posterior mobility and transfer of milk for swallow.
Right breast (some sore spots / developing mastitis?), 16mm shield applied. Cross-cradle hold with hand-over-hand assist for increased postural support. Light touch facilitation of rooting to bottom lip, tongue tip stimulation to facilitate cupping forward. With optimal jaw ROM and tongue cupped anterior to bottom lip, mouth brought onto shield for spontaneous non-nutritive suck (NNS). Initially occasional audible swallow until let-down, then well-coordinated, self-paced, mature suck pattern, no clicking/leaking, sustained x 5 minutes, then fell asleep. With continual stimulation to hands, feet and cheeks: 5-7 suck bursts with audible swallow, then stop. Continued x 10 minutes.
Left breast: Brief skin-to-skin for burping, oral-motor intervention to re-alert, re-latched cross-cradle with shield. Brief NNS to activate let-down, then active well-coordinated, mature suck pattern x 3 minutes, then fell asleep.
Stayed asleep through burping (arms and body limp), then became intermittently fussy, rooting toward hands.
Feed Assessment (Bottle)
Held in elevated side-lying. Oral-motor facilitation for jaw ROM and tongue cupping (to mimic breast latch). Latched to empty Dr. Brown's Preemie nipple with vigorous NNS. Milk entered nipple horizontal to gravity. Well-coordinated, mature suck pattern, no clicking/leaking. Modified with a breath every OTHER suck (Preemie nipple slower than mom's let-down, OK for while establishing breastfeeding). Took 30cc and fell asleep. Briefly re-alerted and fell back asleep in side-lying with mom, skin-to-skin.
OT Goals
Home Program: Oral-Motor Exercises
Using your pinky finger, do these before every feed within baby's tolerance:
- "Gum" massage: Inside lips, outside gums, gentle clockwise massage. Watch for increased jaw excursion and tongue lateralization/cupping.
- Resistive chewing: Rest lateral surface of your pinky on upper gum ridge slightly lateral of middle. Watch for rhythmic chewing and tongue seeking with cupping toward stimulus. 5-7 reps or until baby is frustrated.
- Tongue tip stimulation: Stimulus to tongue tip to draw it forward with cupping.
- Non-nutritive suck (NNS): Empty nipple (bottle), finger, or pacifier ~ 5-7 reps to develop rhythm BEFORE milk enters mouth.
Home Program: Developmental Positioning
Work within baby's activity tolerance, frequently throughout the day:
🔵 Supine (back): Support pelvis during diaper change. Support UEs with your hands or light upper swaddle. Facilitate hands to mouth and downward gaze toward caregiver doing the diapering. With same support: fixate on object in lower visual field (12-18" over chest), moving toy slowly in arc to facilitate tracking to end range, stopping/slowing if she loses fixation.
🟢 Side-lying: Support at pelvis and shoulders. Facilitate hands to mouth for neutral alignment (hip, shoulder, ear aligned). Gaze in lower visual field at toy in front of chest. May offer gentle mobility of UE supporting at shoulder.
🟠 Prone (tummy time): Support UEs for weight-bearing vertically through elbows to shoulder. Gaze at toy on surface in front of hands. Offer tracking by moving toy laterally on surface.
*Tracking activities may be attempted after baby begins to show interest in looking at faces/objects.
Recommendations summary
- Peri/intra-oral stimulation before EVERY feed to facilitate jaw/tongue ROM, cupping, and rhythmic NNS
- Handling to facilitate neutral alignment when in arms
- Developmental positioning opportunities every time baby is awake
- Proximal support to facilitate hands to mouth / downward gaze in all positions
- Frequency: Evaluation only (home program, no ongoing OT sessions recommended at this time)
🙌 Craniosacral Therapy
Session notes
Findings & Treatment
- Metopic suture: Mildly overlapped → treated
- Sagittal suture: Mildly overlapped → treated
- Coronal sutures: Mildly overlapped → treated
- C2 vertebra: Mild yet persistent rotation → treated
- Palate: Slightly high, but not narrow → bilateral sphenoid lift to help decrease palatial height
- Sacrum: Slight restriction → treated
Relevance to feeding
- The slightly high palate may affect latch depth ~ treated with sphenoid lift
- C2 rotation could affect head turning preference during feeding
- Suture overlapping is common after precipitous births (fast delivery = skull compression)
- All findings are mild and were treated. May benefit from follow-up sessions
🌟 Milestones
What to watch for (NOEL Method framework)
Week 2 (current) ✓
- ✅ Primitive reflexes present and appropriate (Moro, rooting, stepping)
- ✅ Lifts head 30° in prone
- ✅ Turns head both directions
- ✅ Smooth random movement in all planes
- ✅ Hands to midline/mouth
- ✅ Self-triggering Moro with spontaneous recovery
- ✅ Rooting toward hands
- ✅ Back above birth weight
Coming up: Week 4-5
- ⏳ First social smile (NOEL babies tend to smile at 4-5 weeks)
- ⏳ Longer tummy time tolerance
- ⏳ Better head control
- ⏳ More alert wake windows (30-45 min)
- ⏳ Moro reflex starting to fade with free movement
Coming up: Week 6-8
- ⏳ Laughing/cooing back at you
- ⏳ Visual tracking improving
- ⏳ More purposeful reaching
- ⏳ Peak crying period (6 weeks) then declining
- ⏳ Breastfeeding becoming easier and less painful
Coming up: Week 10-12
- ⏳ Head all the way back over shoulders in tummy time
- ⏳ Beginning to inch forward (army crawl precursor)
- ⏳ Startle reflex mostly faded
- ⏳ Much more coordinated overall
- ⏳ Breastfeeding well-established (6-12 week mark)
📝 Notes
Running notes and observations
March 25, 2026
- Started nipple shields ~ only way to latch currently
- Working on weaning off ASAP (mid-feed switch technique)
- Kelly implementing Thompson Method positioning
- Started co-sleeping / increased skin-to-skin
- Following NOEL Method for daily routine (tummy time, floor time, observe cues)
Birth story summary
Precipitous (fast) home birth at 39 weeks. Uncomplicated SVD. Immediate skin-to-skin, latched within one hour. Beautiful start. Latch difficulties began at Day 3, leading to significant weight loss by Day 5. Triple feeding protocol got weight back on track. Now working to transition to exclusive breastfeeding.
Send me any new practitioner notes, weight checks, or observations and I'll add them here 💜