This is an interesting thread.  I have never made it a practice to routinely
examine babies by digital exam. However, there are times when I simply
cannot get a good idea of the extent of a baby's problems without a gentle
digital exam.  A high arched palate, a low tone or high tone tongue, weak
suction, poor lip tone that creates weak seal, weak jaw closure, or jaw
clench can be evaluated to some extent visually if the baby can be brought
to breast.  But I see primarily babies who aren't nursing well or at all.
Trying to assess them without some evaluation of their mouths is like trying
to do a gyn exam under a sheet with the doctor's head turned.  I do think
"intention" is important, as is learning about what stress cues look like in
infants.  Most of these babies are sucking on parental fingers, pacifiers of
all shapes and sizes, bottles that are inappropriated suited (i.e. poor
shapes, sizes,  and flow rates) to their specific feeding problems.  My
brief attempts to go in and gently assess the size, shape and
strengths/weaknesses of the mouth and the muscles of some of these babies is
in the interest of diminishing the inappropriate interventions, and
substituting some that might support what the baby is capable of and
strengthen the baby.  The goal is to move the infant to normal feeding (i.e.
nursing at the breast).  Many times I can SEE what I need to know, but there
are times I must FEEL.

The word intervention seems to be getting some bad press. Setting a broken
leg is an intervention.  Pulling out a splinter is an intervention.
Sometimes problems resolve on their own, but often problems require
intervention.  Ideally, one's life is spent without needing too many
interventions, but when they are required, please God, send me someone who
will perform the intervention without hurting me.  I submit that the problem
is not intervention itself, but stupid interventions.  The precipitous
decline of breastfeeding in the first few weeks of life in all populations
speaks to the fact that women need help in the learning period, don't get
enough informed assistance, and quit (often in despair) because the advice
they get tends to be inconsistent and ineffective to solve their problems.
The big reasons women wean are perceived or real insufficient milk supply,
and sore nipples.  A few sensible interventions there would be a blessing.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.lactnews.com

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