Julie Tardos asked, "Why do some babies pull back on the breast (staying latched) when they have been breastfeeding for several minutes?"

Whether the infant stays latched and pulls back on the breast or the infant releases the latch after nursing for several minutes, my hypothesis is that the initial milk release is slowing down/stopping at this point, prior to the onset of a subsequent MER.  When a baby has not yet reached satiety, this behavior is not unusual, particularly in youngest newborns who are just beginning to learn that they can make more milk happen by  continuing to nurse.  Across the lifespan, the motor learning of all feeding and drinking skills is a process of trial and error learning as we rehearse feeding movements.  As we build increasingly greater motor control during the repetition of practice, we discover the consequence of our correct feeding movements when we receive food or liquid for our efforts, and this consequence soon becomes the expected sensory consequences that follow our correct feeding movements.  A helpful graphic on sensory-perceptual-motor learning:

 sensation ----->   perception ----->     cognition (action planning) ----->     action (response) ----->   consequence (expected sensory consequences) 

This infant behavior of pulling at the breast and/or releasing the latch prior to satiety can be studied with ultrasound on the breast, re: average MER duration as seen in the seminal work by Geddes, Kent, Hartmann and colleagues, by observing and measuring the infant's behavior re: the timing of the onset of such behavior (pulling back but sustaining the latch or releasing the latch and displaying hand-to-mouth behavior and rooting/search behavior).  When clinicians describe an infant as "flow-confused," such study would provide greater insights into the phenomena of this feeding behavior.  

Some newborns are content to continue nursing while waiting to discover a subsequent MER, particularly as very sleepy young newborns.  Some newborns less than 3 days of age may release the oral grasp within 2 - 9 minutes of beginning the feed, but immediately display hand-to-mouth reflexive behavior and rooting/search reflexive behavior.  Until babies discover via trial-and-error motor learning that they can make more milk flow again at the breast during that feed, behaviors of releasing the latch with immediate displays of hand-to-mouth behavior can be observed among a number of youngest infants, while other infants may sustain the latch but pull back on the breast.  Sleepiest (Day 1 and Day 2) young newborns are more likely to sustain the latch and nurse to satiety on the first breast (when they have learned how to sustain the latch and suck in an effective manner), and if not yet sated for the entire feed, will typically nap between breasts for one to 30 minutes, with 5 to 10 minutes of napping between breasts commonly seen in youngest newborns.  

Daytime sleep as well as nighttime sleep helps us to consolidate (or strengthen) our learning.  In-session learning is active learning that takes place during practice, and between-session learning takes place between rehearsals.  This between-session learning includes learning as we sleep, as the brain and the rest of the central nervous system continue to process our learning around the clock.  

For more on sensory-perceptual-motor learning toward robust motor memory for the oral grasp and effective suckling, please visit the More Than Reflexes website at http://www.MoreThanReflexes.org/on-learning.

For expanded content, please see webinar information at http://www.MoreThanReflexes.org/webinars/

Will provide the formal webinar description in a separate post (More Than Reflexes:  Learning, Forgetting, and Relearning Infant Breastfeeding Skills ~ Integrating Precepts from Breastfeeding Science and Kinesiology, the Study of Human Movement, Motor Learning, and Motor Control).  

With warmest regards,

Debra Swank, RN BSN IBCLC
Ocala, Florida USA
More Than Reflexes Education
http://www.MoreThanReflexes.org

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