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Subject:
From:
Mardrey Swenson <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 17 Feb 2004 11:43:54 EST
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Cherie Rice asks: " Do any of you have any ideas for a hands-on teaching
strategy illustrating the difference between the breast and bottle in a baby's
mouth?"
Subject: Breast, Bottle Sucking Patterns Teaching Strategies

"Hello, Fellow Lactnetters!
I will be presenting a 30 minute session on "Sucking Patterns, Breast vs
Bottle" at a Lactation Conference next week.  My session will be geared for
new IBCLCs, WIC counselors, nurses, etc.; not advanced practice LCs."

I do need to make a comment on this topic. I was well trained to read all
sorts of x-rays in my previous profession. One of the times I heard Michael
Woolridge talk he showed the old x-ray movies -- cineroentgenography -- of babies
sucking at the breast and the bottle. He wanted us to see the mouth, jaw, and
tongue action of the breastfed baby at the breast. The bottle feeders had a
barium solution in the bottle. The breastfeeders had the breast coated with a
radioopaque cream that showed the outline of the breast.

When the baby was latched on deeply at breast and when the bottle was placed
in the baby's mouth so that the lips are on the broader base (and not on the
narrow part of the nipple teat) as the babies were in these moving x-rays,
there was no difference in tongue movement between the two types of feeding. I
even went up to Michael afterward to discuss that there were no differences and
he agreed.

If we go back a few decades to when the concept of bottle-feeding differences
was brought into the arena of breastfeeding, bottle feeding was accused of
causing different actions of the tongue -- one being the possibility of stopping
a fast flow from a large nipple opening.  Although this might occur, it might
not in the majority of bottler feeders.

I see all kinds of funny tongue movements some babies are born with (apart
from tongues with the back of the tongue raised and the tip pulled back) --
sticking their tongues way out, pointing them, pushing their tongues against their
little fists or fingers. These actions may linger longer in some.  If these
babies don't latch well, or by their tongue actions disturb their feeding at
the breast to a great degree (and I have seen this), then in the past babies
like this may have been bottle fed. If the mother still had difficulty
breastfeeding her baby, and then used a bottle, then sought breastfeeding help, I can
see how someone might have concluded that the bottle feeding had caused the
tongue actions.

I see that babies can have different tongue habits and that when the milk
begins to flow well and the suck swallow breathe is rhythmic, that the habits can
change to a good tongue action in most babies.

 When a baby isn't latching deeply on the breast and the nipple doesn't
extend back far into the mouth along the tongue I imagine that friction can occur
that can injure the skin of the nipple. When the areola/nipple is deep in the
mouth and the tongue rises up to press into it there is no friction rubbing the
tip of the nipple. If the nipple is not deep into the mouth and therefore not
far back along the tongue, then when the back of the tongue rises it can slip
on the nipple tip as it rises and meets the palate (instead of the nipple
that should be back there). It can also cause a wedge shape to the nipple. This
same action could be reinforced with bottle feeding or a pacifier or even by
sucking on a finger if none of them are back far enough in the baby's mouth.

Therefore I think it is difficult to talk about the differences between
breast and bottle feeding.  We can talk about how to bottle feed well -- with the
baby's mouth open well, the bottle nipple deep in the baby's mouth, and the
lips flanged on the wider part of the bottle nipple.

 We really don't always know what is happening inside the baby's mouth. We
can have the baby suck on a finger to get a feel for any irregular tongue
positions or actions and discover that some are more out of the realm of normal than
the other.  Some babies who have more complex tongue problems don't feed well
at breast or bottle.

Mardrey Swenson DC, LLLL, IBCLC

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