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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