Cathy

I was intrigued by your suggestions for the non-latching baby where 
you described that,
"The salient stimulus for latch is the tongue
tip contacting the breast. If the breast is 'in' the baby's mouth but
the tongue tip is not touching the areola, it will feel like nothing is
there to the baby and he'll continue to root (moving his head side to
side to try to contact the breast) and will cry if this doesn't work."

Lower down in your post you reiterated what you'd said, "Presenting a larger
mouthful of breast to the baby's tongue tip while the nipple brushes the
philtrum (that cute little dent between nose and upper lip) pushes the
'right' buttons for baby to open wide and grasp the breast."

I'm really intrigued, and would like to learn more, because way way 
back when I was still learning how to latch babies, I read (I think) 
a publication called "An Overview od Solutions to Breastfeeding and 
Sucking Problems" by Susan Meintz Maher, which described how the 
primary requirement for latching was for the baby's _palate_ to be 
stimulated.  I've mislaid this publication when I moved country,  And 
because I love working with latching difficulties and found this 
information to be very effective in my difficult-to-latch babies, 
either showing the mother how to stimulate the palate with her 
nipple/areola (flipple technique, tea-cup technique) or doing it 
myself, I totally fascinated to hear you say that it's another 
completely different kind of stimulation (areola to tongue tip) that works.

Can I be cheeky and ask if you could possibly share any references 
and especially links that describe what your'e explaining??

Pamela Morrison IBCLC
Rustington, England
-------------------------------------------------------
Date:    Mon, 1 Jun 2015 10:35:48 -0400
From:    "Catherine Watson Genna BS, IBCLC" <[log in to unmask]>
Subject: Re: breast refusal

The breast is generally soft the first day or two after birth, and then
becomes firmer, creating more of a challenge to babies who have
restricted tongue mobility. The salient stimulus for latch is the tongue
tip contacting the breast. If the breast is 'in' the baby's mouth but
the tongue tip is not touching the areola, it will feel like nothing is
there to the baby and he'll continue to root (moving his head side to
side to try to contact the breast) and will cry if this doesn't work.
After a few days of frustration and little milk (another consequence of
one's tongue not having proper range of motion) babies can shut down and
refuse to be frustrated further.

If you are not sure there is a frenulum, absolutely get some body work
for this baby, then reassess tongue mobility. Your tube under nipple
shield strategy was a good one, but it needs to be done in a way that
does not frustrate mom and baby. Take a step back and start having baby
'latch' onto the bottle, start mom bottle feeding with baby's cheek
touching her bare breast, and controlling the flow from the bottle. Then
offer baby breast for dessert when he is calmer. Presenting a larger
mouthful of breast to the baby's tongue tip while the nipple brushes the
philtrum (that cute little dent between nose and upper lip) pushes the
'right' buttons for baby to open wide and grasp the breast.

We've all sometimes stressed moms and babes to try to make it work at
the consultation, I know I have. I hope you'll be able to have a follow
up where you can all be less stressed. Calm yourself, scaffold mom (help
her stay calm) and she'll be able to help her baby better.

Catherine Watson Genna BS, IBCLC  NYC  www.cwgenna.com


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