Hi Cathy
Thanks so much for that further info about gape
and latch. Particularly that the tongue info -
that the tip of the tongue needs to touch the
breast - is based on your own practice, photos
and experience. I'm looking forward to my next
latching difficulty so that I can have another
look for this too :-) We can never stop
learning!! It could be that I have this already
on my subliminal checklist, since I find it
essential to stand/sit at the _side_ when working
with a mom with a difficult-to-latch baby - and
the most important thing (besides, for me, the
nipple going _up_ into the palate) is the
placement of the baby's lower jaw on the
underside of the areola.... and of course the
tongue is over the lower gum.... and to get the
mouthful and then the magic moment when the baby
latches and doesn't lose the mouthful, it could
well be that I intuitively checked for what
you've seen without really noticing! But now
I'll be actively looking for it. Thank you!!
Meanwhile, a very kind and gracious colleague
just gifted me a copy of Susan Meintz Maher's
Overview of Solutions to Sucking Problems, and
what a veritable goldmine of information it is -
full of so many tricks and tips and strategies to
resolve latching difficulties and a hundred other
problems - it's been so long since I read it I'd
forgotten just how many tools in my IBCLC toolbox
this author is responsible for! On palatal
stimulation she says (page 18) “….the baby should
grasp enough of the breast so that the nipple
touches the roof of his mouth at the junction
between the hard and soft palates. This is what triggers effective sucking….”
Clearly I took this information to heart. I've
taught moms how to latch babies, at the breast
direct or with a shield, and moms and dads and
helpers to calm babies with an upturned finger or
with dummies/pacifiers, or bottle-feed, or
finger-feed, by directing the stimulation to the
palate and not the tongue, and yes, that does
definitely work. In fact I've found that placing
the stimulus on the tongue will fail to trigger
the latch and may in fact trigger the gag reflex
if the stimulus is placed too far back and
downwards (on the tongue) rather than up (on the
palate). My observation is that continued
terrier-like rooting shows that the baby is still
looking for something to suck, often they will
arch backwards and even further backwards as they
seek that stimulus. Could this be the reflex
seeking that Suzanne Coulson has described in baby-led latching?? Maybe....
I remain intrigued by whatever is necessary to
help non-latching babies. If the baby can't
attach to the breast, then breastfeeding simply
can't take place, so it's crucial. Thanks Cathy
for sharing this further technique!
Pamela Morrison IBCLC
Rustington, England
-----------------------------------------------
Date: Tue, 2 Jun 2015 09:20:46 -0400
From: "Catherine Watson Genna BS, IBCLC" <[log in to unmask]>
Subject: Re: Stimulation to latch
Hi Pamela,
The palate stimulation comes next, that's the next thing babies expect.
The philtrum information (that touch there stimulates the widest gape
and head extension) is from a pediatrician who cataloged infant reflexes
and their stimuli, Dr. Prechtl. He was T. Berry Brazelton's mentor.
The tongue information is based on my own practice and years of close-up
photography of babies struggling to latch. If the tongue tip touches the
breast, they've got it. If it misses, they continue to root or give up.
I too got a lot out of Susan's paper, still have a copy. She based a lot
of it on speech therapy thought at the time (1986, I believe).
Basically, if what you are doing works, keep at it!
Catherine Watson Genna BS, IBCLC NYC www.cwgenna.com
---------------------------------
Date: Tue, 2 Jun 2015 18:38:45 +0200
From: Kika Baeza <[log in to unmask]>
Subject: Re: breast refusal, gag reflex, nipple shield
Following Cathy and Pam's thread...
Saw a baby this past week that completely baffled me. Month old child,
being breastfed with nipple shield and supplemented with bottle fed mother
milk and formula because he was failing to thrive.
Mother 's reason to consult was that she wanted to wean off the shield
because she thought it was the reason for the ftt.
Baby"s oral assessment showed normal structures and a surprisingly marked
gag reflex, which was activated by just placing my finger at the front of
the hard palate, almost right behind the alveolar ridge.
Mom had learned to put the bottle into his mouth sliding it on his tongue
so he did not gag.
What surprised me was that he did not gag with the nipple shield. He did
not suckle effectively either, he had a strange fibrilating-rolling
movement (can't describe it better) with no swallowing, but the latch was
surprisingly deep with no gag.
Without the shield he would place his open mouth on the nipple and do
nothing. He did not explore it with his tongue except once very
tentatively. Nothing we tried (and I tried all the things Cathy describes
to the best of my ability) got him to latch.
Seeing all this, added to him being a breech baby born by c-section, I have
sent him to CST with the very best therapist I know. But I could not
interpret all these symptoms nor help this dyad on the latch issue.
Fortunately mom was happy with the support and the consultation since
everyone had been telling her baby was a great breastfeeder and to just
wean him off the formula. She was glad to confirm her gut feeling that
something was wrong.
Any wise ideas? There is so much to learn!!
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