I've dealt with this twice in the last couple of months, both coming to
me at ages 2+ mos, which makes it so much harder. The first didn't hurt
her mother, just literally kept falling off of the breast and swallowing
a ton of air in the process, and was also starting to falter in weight gain.
Baby was resistant to suck training but willing to nurse lying on top of mom
face down, a position which would force her to actively draw and hold the
breast deeply in her mouth (she doesn't even turn her head to the side!). I
had the mom work diligently to get baby to take a mouthful of breast at
latch-on in this position, and we got rid of most, though not all, of the
clicking, with baby swallowing less air. Mother was not motivated to work on
suck training but was happy to have found a position to breastfeed in, period.
She chose to keep this as her fix, though it is certainly less convenient.
Baby does fine this way, but she still cannot stay on in traditional
positions.

Case 2 still in progress. Mother has successfully fed previous baby, but
this one clicks terribly despite excellent technique and hurts her; from
a healed up point, she starts bleeding after 4 feeds. Baby VERY resistent
to any position changes and anything other than breast or bottle. Sunny
personality until you mess with the feeding.... then he screams! Palate
perfectly normal, but he does all kinds of things with his tongue that
aren't right, possible tongue thrusting, possible reverse peristalsis,
poor lip seal, constant loss of tongue contact..... Mother and family has
history of severe dairy allergies + citrus, but mom has been dairy free
one month already. She wants very badly to breastfeed, is highly
motivated. I asked her to work on finger feeding, to work up to it as
much as she could; I couldn't do to much with the baby myself because he
became upset very easily, which made assessment difficult as well.
Interestingly, he displays difficulty coordinating suck and swallow with
bottle feeding with NUK and finger feeding, sometimes even at breast as
well. Doesn't have it together at all, but neurologically he seems
perfect in every other way. Mom has worked at finger feeding, pushed baby
more than I wanted to, and saw a gradual improvement in suck and swallow
and associated clicking as they progressed and baby had to work around
the finger instead of manipulating it like he was used to. She jumped
back to breast before I would have liked, but says he is doing much better,
clicking less, hurting less. A difficult case with slow but definite
improvement. (Mom had previously been working with another LC who told
her to pump and bottlefeed until healed, then try him back; it was an
endless cycle with no improvement in sight after a month. Her aunt is a
friend and asked me to talk with her because family was getting down on her)

I offer these cases as food for thought in addition to Denise's excellent
questions.

-Lisa
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Lisa A. Marasco, IBCLC                                /  [log in to unmask]
International Board Certified Lactation Consultant    /  [log in to unmask]

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