Check out the baby's coordination of swallowing and breathing. If you 
have a stethoscope, you can bring it and place the head under his chin, 
and listen. If you hear anything but a smooth, slightly biphasic click 
(cuh-lick), there might be a problem. Should not hear bubbling, 
whistling (stridor), or gulping; nor should you hear congestion that 
increases in severity as the feeding progresses. You should be able to 
hear smooth coordination between swallowing and breathing. You may hear 
vocalization (7 month olds can be chatty, even while feeding), but this 
is not a problem unless it's unhappy sounding.

One neat trick if the baby is struggling with flow and mom leaning back 
so the baby is prone doesn't help is Carol Chamblin's discovery: have 
mom place a flat hand on her breast to close off some of the milk ducts 
during the MER. usually this is only necessary during the first MER, 
because it's the strongest. Then mom lets go and lets the baby finish 
with all the ducts flowing, to avoid plugs.

Make sure the baby is growing and gaining before you work on decreasing 
the milk production further by stretching the time before changing 
breasts, tongue tied babies can have a hard time handling a normal milk 
flow.

Catherine Watson Genna, IBCLC  NYC

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