I agree with your indications for a digital exam.  One way to avoid 
having a digital exam be invasive is to allow the baby to decide whether 
or not to let your finger in. If you hold the baby, talk gently to him, 
and place your finger gently across his lips, he'll usually open up and 
attempt to draw your finger in to suck. If the baby is reluctantand you 
need to do the exam, you can try gently rubbing the baby's lips with 
your fingertip until they relax, and then rub the baby's gums. Once 
you're rubbing the gums, the baby will usually relax and let you do the 
exam.

The only part I find babies don't like is if I need to lift the tongue 
to look underneath.

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com


On 4/10/2011 9:12 PM, Tania Archbold wrote:
> That is pretty much when I do a digital exam.
>
> I only do one if I suspect a tongue tie and it isn't glaringly obvious visually. I always ask a parents permission and I always wear a glove after washing my hands.
>
> I haven't yet had the opportunity to see other palate abnormalities other than the tongue tie - high palate combo.
>
> Tania Archbold B.Sc. IBCLC (2010) LLLC
>
> On 2011-04-10, at 21:07, Laura Spitzfaden<[log in to unmask]>  wrote:
>
>> Thank-you for the reply.  I think you're right that I just need to see a lot of normal palates to see what is not normal.  It would be really helpful if there were multiple photos of palates available to help those of us who haven't looked into many babies' mouths.
>>
>> I am interested in hearing more about when you and other experienced LCs think it is a good idea to do an oral assessment on a baby.  I too, think it is intrusive.  As a LLLL, I never put my finger into a baby's mouth (other than my own children) and as an IBCLC, I don't think I should do so unless necessary.
>>
>> Under what circumstances do you or others think it is indicated to do so?
>>
>> I'll list some that I can think of here:
>>
>> -A non-latching baby who has been given the opportunity to try to latch in biological nurturing positions and when other techniques also fail to help them latch
>>
>> -A baby who continues to latch shallowly (and is causing mom pain or has low milk transfer) when given the opportunity to latch more deeply
>>
>> -When baby is causing compression and damage of the nipple even after attempting better latch and positioning techniques
>>
>> -Laura Spitzfaden
>>
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