Teresa,
How I wish I didn't have as much experience as I have had these last two years
with lower-lip and tongue suckers!  They seem to predominate with cesarens, but
not always - last week I had twins, 38 weeks gestation, both over 6 lbs, vaginal
delivery - one with tongue sucking and one without!  Mom was feeling very
negative about the tongue sucker as it hurt to breastfeed him.  This only 12
hours after delivery!  "He bites me." "He doesn't like me." were the first
statements out of her mouth.

My usual "modus operandi" is as follows:

(I have gloves on both hands as I never know what finger I may need to use to
rescue a "bitten" nipple)

        1. Have mom sit on chair and place baby with nose to the nipple (rather
than mouth directly opposite the nipple) so that baby needs to reach "up" to
open mouth to breastfeed.  I especially like the football hold for this, but it
can be done with cradle  also - just put baby's head on forearm, not crook of
elbow.  And stress to mom that back of head is NEVER to be pushed.
        If baby does grasp breast an nipple, but it hurts, I reach with my index
(gloved) finger between lower jaw and mom's breast and pull down on the lower
lip and chin.  Sometimes this is all it takes - baby learns that milk
(colostrum) flows easier if breastfeeding this way and you're off an running.
                        if this doesn't work

        2. Have mom lie down and put baby on top, skin to skin, also below the
level of the nipple so baby needs to reach and go after the nipple.

                        if this doesn't work

        3. Use baby's own fingers (3) to encourage sucking something larger than
the lip or tongue and allow more enter his or her mouth.  Then return to 1
(above).

                        if this doesn't work

        4. Do some suck training, using gentle (gloved) finger insertion.  I
usually find these kiddos also have a fast gag reflex so it's very important to
be gentle and not let the gag reflex create a negative attitude towards things
entering the mouth.  Usually 5 minutes of this and I can get baby to follow step
1 (above).

                        if this doesn't work

        5. Use cup feeding and syringe suck-training to feed baby for a day or
two.  IF mom stays in the hospital (has had a cesarean delivery) for 3 days, I
usually find baby's tongue sucking diminishes around day 3.

          if this doesn't work or baby is being discharged and it's pretty clear
mom is about to quit:
                `
        6. Use Nipple Shield (evert then place over breast then return to
original shape to pull in plenty of breast along with nipple) to provide a
large, formed object that doesn't allow tongue to be up and therefore prevents
tongue sucking.

        Good luck - you need a persistent mom with this one.  (I was able to get
the twin to breastfeed without pain ONCE during her stay - whether she will
continue or not...???)

Jeanette Panchula, BSW, LLLL, IBCLC, RN
Puerto Rico
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