The OT/PT literature describes the gag reflex as occuring about mid-way back
on the tongue of a newborn, and further back for an older baby.  So it is
unusual for Peg's baby at 2 months to be gagging so readily with such
shallow contact.  I suspect the mother who was "incorrectly using the Avent"
ie not putting it back far enough was appropriately (if unconsciously)
responding to baby's aversion to deep penetration.

While walking back the tongue and suck training can help some babies
over-come fear of objects going deeper into their space than they can
tolerate, these are maneuvers that need to be taught very carefully or they
can actually make things worse.  I teach moms to observe for stress cues
(eyes widening, grimacing, stiffening, gaze aversion, arm flailing,
finger/toe splaying, arching).  As soon as the baby begins to look worried,
you back off.  The consequences of over-riding the baby's tolerance level is
the potential to worsen what may be a sensory defensiveness or conditioned
dysphagia.

 Newborns don't have too much ability to avoid force feeding, but as infants
get older, they begin to protest feeding if something about it has been
stressful for them to manage.  It may be a related respiratory issue, it may
be reflux, it may be a subtle neurological problem.  I once saw a three
month old start such a pattern, and over a week or so, become very ill with
what turned out to be botulism.  It isn't normal to not want to feed
robustly at this age.  I don't know if I would treat this per se as a
breastfeeding problem.  Another reason I say that is that it appears that
the infant's aversion/problems cut across all modes (i.e. bottle, fingers,
as well as breast).  This is a red flag to me.  I think I would initiate a
dialog with the pediatrician by describing what you have observed the baby
doing.  Don't draw any conclusions, but let the pedi know you feel these
feeding-related issues are baffling you and you want him/her to rule out
organic illness.  Be sure to mention the problems occur with the bottle
feeding as well.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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