I am concerned about blanket statements regarding any use of a finger in a
baby's mouth as "oral intrusion." As far as I am concerned, bottle nipples
and pacifiers are just as much intruders in a baby's mouth as anything.
Parents (including myself!) have used a finger in a baby's mouth to pacify
them, especially during car rides or while waiting for mom to be ready to
feed, for quite a long time now, and seldom with ill effect.

Before throwing the baby out with the bath water, may I suggest that those
who would like to know more about suck training try contacting someone with
expertise in this? Chele Marmet has been teaching it for years, and
lactnetters such as Cathy Genna employ it skillfully in their practice. I
also do some finger-feeding in my practice, and some suck behavior
modification, as needed. 

Kathleen Bruce mentioned that she has not ever had someone really answer the
question, "what is suck training?"  That is probably because the definition
varies from person to person due to lack of standardization of this tool in
our profession. At the very lowest level, it can refer to something as
simple as helping a baby to re-organize his suck by sucking on a finger. I
have done this many times....... A baby with breastfeeding problems
sometimes may exhibit lots of aberrant and unproductive motions when he
first starts to suck on my finger during an assessment, but after 5 minutes
of just sucking on something that doesn't manipulate easily in his mouth, he
will begin to organize his suckling in a more appropriate manner. Often he
goes to breast much better because he has had a chance to organize first
rather than try out all his aberrant motions on a breast that can be more
easily manipulated, pinched, etc. (Remember, these are babies having
problems, not the general population!)

A little up the ladder, "suck training" can involve gentle modification
techniques such as applying light pressure to the back of the tongue while
baby is pacifying on the finger in order to encourage the tongue not to
hump, or the practitioner might use a light stroking or tapping of the
middle of the tongue outward to encourage grooving (some do with finger tip
down, some up, etc) or tongue-extension. 

A little further up the ladder still, there are gentle "de-sensitizing"
routines.  For a baby with a bubble palate who likes to keep the nipple in
the bubble only, sucking on a finger that has gently and slowly sneaked back
to the juncture of the hard and soft palate can help de-sensitize him and
prepare him to accept a deeper latch. Babies are orally defensive may need
help in having more pleasant experiences before accepting a breast. 

More up the ladder still are techniques to stimulate the oral muscle tone
and help a baby to focus, such as first stroking the outside of his mouth to
cue him to oral work. I am not as well-versed in these techniques as some
others are. 

This is not an exhaustive list, but rather examples of things that have been
used to help breastfeeding when our other usual tools have not fixed
everything. The most important aspect of suck training is, first and
foremost, to RESPECT THE BABY. Techniques should be chosen for
appropriateness and then introduced slowly, gently, and respectfully.
Barging into baby's mouth and forcefulness are not acceptable. Equally
important is knowing what you are doing, how and why. Some LCs have learned
their techniques from occupational or speech therapists. Others have learned
them from other skilled LCs.  The worst thing is when someone hears about
something and then tries it out on a baby without really knowing what they
are doing. That is how suck-training has become controversial in some
circles.

What I am hoping to see happen, and eventually hope to facilitate, is a
meeting of LCs experienced in suck training and experts from outside of our
field to discuss and determine what can be appropriately taught to and used
by LCs in our field. Then, I would like to see more training courses
established and made available to teach these skills, possibly as advanced
LC skills. We need this more than we need to be fearful, especially since it
is difficult in many areas to 1) get referrals for suck issues for
breastfeeding babies who can otherwise bottle-feed effectively, and 2) find
qualified people who are interested in applying their knowledge to fix
breastfeeding. We will not be able to handle all the complexities of the
outside experts, but I believe strongly that there are skills that we can
safely learn and employ appropriately within the scope of the LC. 

In the meantime, let's learn from those who are successful and try to avoid
the mistakes of those who are not.

~Lisa Marasco MA IBCLC

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