Georgia

What a very interesting post, and very good descriptions :-)

As you've observed, the reason that a baby might 
bob around on the nipple is that s/he is 
"looking" for the nipple and trying to latch 
on.  Is it here, No?  Where is it, Where is 
it???? And yes, you are quite right that the baby 
who starts crying is becoming frustrated because 
he's not getting the necessary stimulation to 
latch on. But it sounds as if you're concerned 
that the reason might be that the tongue could be 
tied, or inadequately revised??  But it's not 
stimulation to the _tongue_ which causes a baby 
to latch, but stimulation to the _palate_ (the 
roof of the mouth, usually at the junction of the 
soft and hard palates, ie quite far _back_ in the mouth).

If the baby is being positioned in a laid-back 
position, then he will bob his head, up and down, 
looking for the nipple face down. The head is 
heavy, and it's hard work and he can get very 
tired and very, very frustrated.  If the baby is 
positioned in, say, the cradle hold, he will 
repeatedly gape and arch _backwards_ to search 
for the nipple.  This is very frustrating for all 
concerned, since pushing the baby's head towards 
the breast is absolutely the wrong thing to do.

I'm not a big fan of the laid-back position for 
difficult-to-latch babies, for the simple reason 
that I find that the mother's own position means 
that she can't help the baby very much - she 
probably can't see very well, and gravity causes 
the breast to flatten (like a fried egg), rather 
than be formed into the firm stimulus that the 
baby is looking for to be able to latch 
on.  Thus, I would always suggest the mother use 
a cross-cradle position - holding the baby along 
the back and behind and below the ears, and 
supporting the breast in a nipple-sandwich, with 
her fingers behind the areola and pulling back 
into the chest wall to firm the tissue and with 
her underneath index finger in line with the 
baby's smile.  This creates a space for the 
little receding chin and lower jaw to fit under 
the nipple/areola.   Now, stimulate the baby's 
gape once more and tip the nipple _up_ while 
drawing the baby's mouth on to the sandwiched 
nipple/areola - so that the firmed nipple reaches 
and stimulates the palate.  With an arching baby 
it's necessary to _follow_ the baby with the 
nipple.  Once the baby feels stimulation in the 
right place (far back at the roof of the mouth) 
he will clamp down, sometimes still trying to cry 
at the same time, but once he realizes that there 
is something there to suck, then he'll take a 
tentative suck, and then another.  Sometimes at 
this point the baby will just stay latched 
without sucking and this is fine as that warm 
little mouth (and lack of crying!) stimulates the 
mother's let-down reflex.  Then there might be 
another quick shallow suck or two and and then a 
few slower sucks as the baby starts 
swallowing.  And then you have lift-off as he 
starts to breastfeed.   The relief can be indescribable.

Helping a mother of a non-latching baby can be 
one of the most difficult, exquisitely delicate, 
fraught but ultimately rewarding parts of our 
work, I find...... I get in there and am really 
hands-on if the mother and baby can't manage, 
because once you physically teach the baby what 
to do, and then explain to the mother how to go 
along with the baby's own reflexes and need for 
palatal stimulation, then - and only then - she 
can become self-reliant.  I know that in England 
there's this thought that we shouldn't physically 
help the mother otherwise she wont be able to 
learn for herself.  But I think that watching a 
baby bobbing up and down and becoming 
increasingly frustrated from the end of the bed 
with our hands firmly behind our backs is 
actually cruel.  Furthermore, if a baby starts to 
cry too much in my hearing, I start to shake - I 
just can't stand it!   So I make a few 
suggestions, but if everyone is getting more 
upset rather than less, I ask the mother's 
permission to touch and help her baby latch for 
her (the answer is almost always, Oh yes, 
please!) and go ahead.  Then once the baby has 
had some milk and the mother can see that the 
baby _can_ do it, then I invite her to try 
herself, and we go through it all again.

As you can see - IME this has nothing whatever to 
do with the tongue, its shape, its position, 
whether it's stimulated or not, nor whether 
there's any tie....... Actually, come to think of 
it, a baby with a TT is easier to latch because 
the tongue cannot extend to the palate during 
crying, preventing insertion of the nipple into the palate!

Pamela Morrison IBCLC
Rustington, England
-------------------------------------------

In observing babies self-latching I have come 
across babies who will bob on the nipple but not 
(i'm guessing) get the necessary stimulation to 
latch on.. they just seem to bob infinitely on 
the nipple, and cry in frustration, even when 
their mouth is going up and down on the nipple... 
in one particular case we tried creating a nipple 
sandwich (mothers nipples were flat but 
definitely not inverted) but i think the tension 
in the areola confused the baby more... i've also 
seen where baby does this and eventually draws 
the nipple out but in several other cases each 
time baby just bobbed up and down on the nipple 
and became increasingly frustrated. i suggested 
sucking skills in the hopes of getting baby to 
extend his/her tongue more to get the feedback 
she/he needed to latch on.. but does anyone have 
any tricks to help baby receive the stimulus they 
need to latch on.. any reason why baby isn't 
receiving that stimulus.. ? on a related note: 
i'm really struggling at the moment with babies 
who have been clipped and have been told that 
there is no tongue tie present but are still 
having a lot of tension in the mid-line of the 
tongue (dimple in middle of tongue, underside of 
tongue flanged at either side when trying to 
elevate, tongue not coming across gum line when 
self latching, strong line down tip of tongue 
etc)  ---and of course seeing me b/c of nipple 
pain, slow weight gain, clicking etc in one 
particular case i observed a hard bit of skin 
under the tongue and the aforementioned 
tightness... but when mother when to dr he said 
no tongue tie... but in all these cases..mother 
was assured that no tongue tie was present... i 
don't want to send mothers on a wild goose chase, 
but after body work, self-latching, sucking 
skills exercises etc.. what else is there to 
do??? any and all thoughts on these issues would 
be greatly appreciated. warmly georgia lay breastfeeding counselor, uk 


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