Another writer posted the thought that the baby with latch problems might be
reacting to a long nipple.  Ultrasound views of nursing infants tell us that
the baby draws the nipple in and during the suction/compression action, the
nipple extends to at least twice it's resting length.  A prominent nipple
(such as the original writer described) may pull back so far it triggers a
gag or situates the nipple so that milk flow overwhelms the baby's ability
to safely swallow.  Nasal regurgitation suggests that this may be the case.
An over-whelmed swallow quickly creates feeding aversion and a tendency for
the baby to "shorten" up on the nipple (ie to pull back and crease it to
pinch off the flow).

Another anatomical reason for the problem might be a sub-mucosal cleft of
the palate.  The soft palate is a muscle.  It drops as the posterior tongue
rises to close off the oral cavity so baby can safely breathe between
swallows and sucks.  If there is a sub-mucosal cleft, the soft palate tone
may be weak and baby may be unable to perform the normal function, again
creating a dysfunctional swallow/breathe phase.

 Long nipples are tricky.  I've taken to carrying a small, clear plastic
centimeter ruler and measuring nipple lengths.  If I get a nipple measure of
say 1.3 cm  I mentally double that for the full everted length.  I have
tested this by measuring during pumping to see what that eversion is.  Often
it's not quite double, but usually the nipple is pretty extended.  Then I
measure on my finger where the baby's lip closes while deeply sucking on my
finger.  This give me an impression of the length of the oral cavity from
lip closure to the spot where the hard and soft palates join (which is the
spot where the nipple generally triggers the suck-swallow-breathe cycle).
If the doubled nipple length exceeds that distance, it gives me info on what
may be bothering the baby.  I may not be able to do much about it, although
altering positions can help some.  Growth will assist if mom can be patient.
I like side-lying position with no effort to hold baby's head in.  Allowing
baby some freedom to pull off reasures the baby.


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

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