In a message dated 96-02-08 12:26:05 EST, you write:
Jan you write:

>a baby that is at the breast for an hour at a time and isn't
>effecting milk transfer needs to be looked into.  And mom needs to know the
>difference.... and they really need to know it is perfectly OK for a baby to
>"hang out."  (And I hate the term 'use me as a pacifier' because I agree
>there are lots of things going on when a baby is nursing -- I do tell them,
>"better that than the baby using the pacifier as a mom.")
>
>

I couldn't agree with you more! Breastfeeding is more than just nutrition.
Physiological breastfeeding includes "hanging out at the breast" as you put
it.

I don't agree, however, with your views on non-nutritive sucking for the
following reasons.

1. Non-nutritive sucking is the type of sucking babies do on pacifiers. It is
done on pacifiers because bottle-fed babies often do not get their sucking
needs met at the bottle because  they do not pace their feed (too fast flow
from bottle) and therefore get full before their sucking needs are met.
Non-nutritive sucking is characterized by a rate of 2 sucks per second
(mean), or twice that of "nutritive sucking". It was a term coined by
researchers who were looking at bottle-fed babies, comparing their sucking
behaviors at the bottle and on the pacifier.

And since mothers aren't pacifiers, this term is not useful to describe
breast sucking in any way.

2. When an infant's oral-motor function is optimal, every suck they take at
breast transfers milk from the breast. Now, it is true that there is a rate
change in breast sucking that is dependent on the flow rate of the milk, but,
even with a slow flow, milk is transferred.

3. High fat milk, released gradually as the feed progresses, must be
optimally removed to ensure optimal milk replacement (Hartman, 1995). This
only occurs if the infant stays on long enough at breast, even if they are at
the segment of the feed where they do  faster-rate sucking.

4. The typical breastfeed is characterized by variability within the feed.
Babies typically begin the feed with rapid (call-up sucking) followed by
sucking that renders milk flow enabling one swallow of milk per suck. This
slower-rate sucking occurs with the MER occurs or when higher volumes of milk
are present in the breast. This slower sucking is followed by shorter bursts
of sucking alternating with longer pauses as the baby gets more and more
full. However, an MER can occur even if a baby is doing the faster rate of
sucking.

5. Because of sucking physiology, it would be physically impossible for a
baby to compress the milk sinuses without transferring milk unless no milk
was present. Or, the baby's oral-motor function would have to be impaired to
preclude milk transference.

Specifically:
A. Deficits of tongue peristalisis would have to exist.
B. Inhibited MER (highly unlikely, this does have to do with survival of the
species).
C. Negative pressure deficits like: poor seal of the tongue against the
breast, lack of the fatty buccal pad causing poor seal, and/or CNS disorders
or neuro-muscular disorders that prevent the tongue from creating a proper
seal. The seal of the tongue must be present for optimal compression of the
lactiferous sinuses to occur. The lips do not create the seal (see Meyer
Palmer's and Bosma's work).
D. A and C above depend upon one another. If you see a deficit in one it will
impact the other.
E. Mother has little or no milk.

Oral-motor disorganization and dysfunction are secondary to a variety of
etiologies and sucking that is non-nutritive, that doesn't transfer milk at
breast, must indicate that there is some impairment of the baby's ability to
transfer the milk.

I believe that the term non-nutritive sucking is a misnomer when used to
describe breastfed baby behaviors when they are at breast. It is a perfectly
fine term to describe the sucking behavior of babies who are not at breast.
We have a hard enough time convincing people that breastfeeding is different
from bottle-feeding without borrowing terms that were created to describe
behaviors of bottle-fed babies. The kind of sucking that Jan refers to as
non-nutritive exists at breast only in the sense of the rate change but not
in the sense of lack of transfer of nutrition. We need to coin our own
terminology so we can stay clear and on the same page.

Recognizing appropriate infant breastfeeding behaviors is part of the LC's
standards of practice. All the more reason to be clear on the facts.

Alison K. Hazelbaker, MA, IBCLC