Jean asked me who I'd refer baby to:

I didn't really go into what kind of practitioner to seek help from on
Lactnet because I think who that would be might vary from region to region.
Here in Austin I might use a cranial sacral therapist I trust and I might
also send the mom to Houston to see a speech path. who was trained by the
Beckman Institute people.  Since you are in Florida, that is really lucky,
and the Beckman people might be the best people to seek out.  I also think a
letter to the ped. is in order.  Don't diagnose, just describe.  "When I
observed the baby, I heard a 'pop' during each jaw excursion at the point at
which the baby's jaw opened to the widest extension."

" When the jaw moves excessively during sucking, it does not provide a
stable base for tongue movements.  This can result in abnormal tongue
movements and inefficient feeding." (Wolf and Glass, Feeding and Swallowing
Disorders in Children, 1992, pg. 241)

You could share that quote in your note to the ped, and add: "The abnormal
tongue movements and the compensations the baby is employing to try to feed
are causing this mother extreme pain and making breastfeeding intolerable
for her.  I would suggest evaluation by a speech path. or PT or someone with
knowledge of the physiology of the jaw."

This would educate the doc about the an effect of physiology on bfg. and you
have made a useful suggestion about what kind of referral might help resolve
the prob.

External support might be useful (a finger placed gently under the baby's
chin will inhibit the jaw from swinging too wide during jaw excursions).
Keep that finger right under the mandible, tho, so you don't put pressure
under the base of the tongue and inhibit tongue mobility.  The amount of
pressure may vary over the course of the feeding.

Hope this helps.

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

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