Lee writes:
"Instead of just counting the stools, they
need to think about what is happening in the mouth; including if 
peristalsis
is occurring properly.  If it is lacking or weak in the mouth, whatever 
the
cause, it will be lacking or weak throughout the GI tract, and 
eventually
out the anus (where everybody is focusing).:-)  Although suck 
assessment is
not the first thing to think about, it is also not the last.  Many a 
problem
has been detected by someone who is well-trained in suck assessment and 
what
to do if the suck is not good.  IMO, that can save many a breastfeeding
situation."

I agree with you, Lee. So often, when I find a baby who is not pooping, 
it isn't just a matter of poor milk transfer or even rapid milk 
transfer. So much is about the tongue and what it is doing. We know 
that the inability of the tongue to milk the breast properly (for 
example, inability to cup or extend) means poor milk transfer in many 
cases, but the converse is also problematic. If a baby is using his 
tongue to defend against oversupply, then he is not using it properly 
either and there may be limited paristalsis, thus gut paristalsis is 
not stimulated. I have often wondered if the reduction in bm's that 
artificially-fed babies experience may not be caused only by the 
composition of AIM, but also a possible limiaiton in paristalsis due to 
the improper use of the tongue. This suggests the possibility of 
long-term structural consequences to gut health caused by AF. This may 
also be one reason why we see fewer than normal bm's in so many babies 
in the first week and beyond--poor tongue function, often caused by 
birth trauma. Again, I would make the point that our frame of reference 
should always be babies born at home. I know few homebirth babies not 
pooping from birth, many times per day. My youngest pooped 7 times his 
first day! I do also want to mention that I think the kind of behaviour 
that we see as defending against oversupply may well be occuring from 
birth as a result of trauma and may actually be the cause of 
oversupply.
Jennifer Tow, IBCLC, CT, USA

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