You're right that you're looking at the sucking patterns in overall picture of how the baby is doing -- energetic, peeing, pooping, gaining?.  One way to present this is that the breast is multipurpose -- providing both food and comfort.  (And "comfort sucking" is a cozier phrase than "non-nutritive.") A newborn needs a lot of both.  You can point out that pacifiers had to be invented to accompany bottles because bottles don't give babies a normal amount of sucking -- when a baby is done with the bottle, the mother needs something else for the baby to suck on so she can rock and cuddle the baby.  Her baby doesn't need a pacifier because they have the real thing.

And you can point out the difference -- the slow, jaw-dropping suck with audible swallows is when the baby is transferring milk, and the baby has to maintain a reasonably long stretch of these to get the flow going.  Sometimes a newborn needs encouragement with stimulation and breast compressions to stay focused.  The comfort sucking is faster and more fluttery.  As long as sucking continues to be comfortable, and the baby also did plenty of effective sucking, there's no need to take the happy baby off the breast.  The comfort sucking has purpose as well, in reducing stress hormones, releasing digestive enzymes, organizing the heart rate and respirations, just making the baby happy, etc. -- that's why they had to invent pacifiers.  The comfort-suckign baby may be "having a cup of coffee" but not moving a lot of milk (unless they trigger another let-down that shifts them back to the slow, jaw-dropping mode).  Milk removal is what drives the production -- not the time at the breast (and those apps that keep track of the time do create the idea that the time is the measure) so mothers do need to know what effective feeding looks like.  An analogy -- when we eat, we stop, put the fork down, chat, have a sip of water, and then go on with our meal.

If a mother temporarily has to pump for a baby having difficulties, then she might opt to ease the baby out of the feeding once she can't encourage active feeding with the compressions and switch nursing, just so she has time in the day to help the baby out with the pump and supplements during this transitional plan.  

You're helping mothers in those very early days.  Mothers are afraid they are going to create "bad habits" with the baby always wanting to do these long leisurely feedings, and the millions of sleep books out there have them worried about the baby getting accustomed to falling asleep at the breast (as babies have done in blissful ignorance for millennia before these books came along).  So you can help them see that older babies do tend to get more efficient because they start to enjoy other things as well -- newborns don't have many interests beyond the breast.

Once breastfeeding is going well, the pacifier may be a tool in the kit, (and a baby in the NICU may need one because they don't have access to a breast) n't you're right to be cautious about throwing a different oral experience at a baby who is just figuring out the breast

Good luck in your work.

Margaret Wills, IBCLC Maryland, USA








> Date:    Tue, 28 Mar 2017 03:40:26 +0000
> From:    Tricia Shamblin <[log in to unmask]>
> Subject: non-nutritive sucking at the breast
> 
> I would love the opinions of the group regarding non-nutritive sucking. I always thought of non-nutritive sucking as being more on a pacifier than a breast. But I listened to a webinar recently in which the LC said it was normal for babies to go back and forth from nutritive to non-nutritive sucking during colostrum production at the breast. She said it forced the baby to suck stronger and longer, and pause for rests, and that this did the best job of stimulating mature milk production. So I guess this is a term that is being used for when infants are swallowing less or very little milk at breast. Makes sense to me, except I wouldn't want to use the term with a patient. For many mothers I think it could create anxiety. Often their worst fear is that the baby isn't getting enough, or the baby is starving to death at their breast. Saying the baby is non-nutritively sucking at the breast would be their worst fear come true. Plus I would think that even in this slower sucking pattern or a shallow latch an infant would just receive less milk, probably not zero milk. 
> I've encountered an alternate opinion from another Provider who feels that non-nutritive sucking at the breast during colostrum production, is a sign of a feeding problem and that the infant should be taken off the breast and the feeding ended because the baby is just non-nutritively sucking. This advice is given to mothers on day 1 and 2 of life. I'm concerned that it also decreases their confidence about breastfeeding.  Now they are wondering if putting baby to breast is the right thing to do because they don't want "the baby using them like a pacifier." Often then the baby is then given a pacifier because it's not nutritively sucking, which creates many more problems. I've always been of the opinion that we shouldn't limit feedings at the breast unless their are signs of a problem, nipple pain, prematurity with fatigue at the breast and weight loss, etc. In the book, "Supporting Sucking Skills," the authors state that a normal pattern would be swallowing and breathing are integrated within bursts of 20 to 30 sucks. And that short sucking in early stages would be sucking of only 3 to 5 sucks with longer pauses. Could it be normal for babies to go back and forth? In most cases I think I would tend to advise that she use breast compressions and continue the feeding if no nipple pain or damage. It seems to me that these long feedings give the baby comfort and some food and stimulate the release of oxytocin. And the authors don't say specifically say that a feeding should necessarily be ended because at that moment the sucking burst is 3 to 5 sucks. I also think that things can change moment to moment. I often tell mothers that I'm not going to judge their babies ability to breast feed by one feeding on day one. This is just one moment in time. I try to look at the overall picture of how the baby has been doing over the past day. Any wisdom from the group would be appreciated. Thank you.
> Sincerely,
> Tricia Shamblin, RN, IBCLC 
> 

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