Hi Pamela,
The palate stimulation comes next, that's the next thing babies expect.

The philtrum information (that touch there stimulates the widest gape 
and head extension) is from a pediatrician who cataloged infant reflexes 
and their stimuli, Dr. Prechtl. He was T. Berry Brazelton's mentor.

The tongue information is based on my own practice and years of close-up 
photography of babies struggling to latch. If the tongue tip touches the 
breast, they've got it. If it misses, they continue to root or give up.

I too got a lot out of Susan's paper, still have a copy. She based a lot 
of it on speech therapy thought at the time (1986, I believe).

Basically, if what you are doing works, keep at it!

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

On 6/1/2015 12:57 PM, Pamela Morrison wrote:
> 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
>
>
> ---
> This email has been checked for viruses by Avast antivirus software.
> http://www.avast.com
>
>             ***********************************************
>
> Archives: http://community.lsoft.com/archives/LACTNET.html
> To reach list owners: [log in to unmask]
> Mail all list management commands to: [log in to unmask]
> COMMANDS:
> 1. To temporarily stop your subscription write in the body of an 
> email: set lactnet nomail
> 2. To start it again: set lactnet mail
> 3. To unsubscribe: unsubscribe lactnet
> 4. To get a comprehensive list of rules and directions: get lactnet 
> welcome

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome