Here's one for the sucking experts in our fabulous group.
Today I saw a mother and 5 day old baby, discharged on day 3 feeding well.
The baby is 8+lb, feeds 2 hourly night and day, has 5 wet and 5 dirty
nappies (which may also be wet) a day, is alert and looks beautiful.
However when he feeds he clicks loudly throughout the feed and in every
position the mother has tried.  This happened only occasionally in hospital
and has been gradually getting worse and worse.  I checked his palate and it
feels completely normal and his suck on my finger was normal with no clicking.

Mother has small breasts, good sized nipples which are quite protractile.  I
watched her attach him and felt it could be improved only marginally - I
then attached baby and though he clicked a little less often then when she
attached him, he still clicked.

The initial burst of sucking he did was a quite rapid choppy lower jaw
movement.  When the MER started he changed to the clicking which appeared to
occur as his jaw compressed the breast, not as he released it.  The mother
said that she could feel the difference when he went from good sucking
(which he occasionally did) to the clicking suck.  She said she could feel
the tension release on her nipple.  Her nipples were not painful or damaged
at all.

I asked about dummies, teats - never had anything except the breast in his
mouth.  No signs of thrush.
Another LC has asked if he perhaps has a soft palate cleft, which I didn't
look for, but didn't feel when I did the suck assessment.  I'll check more
thoroughly for that next time I see her.

The click sounds like when you put your tongue on the roof of your mouth and
forcefully pull it off.  It is quite loud. I did check tongue position while
he was feeding and there it was, just exactly where it is supposed to be.

Basically everything is normal except the clicking as he feeds.  I have been
advised "if it ain't broke don't fix it".  If you agree tell me.

I've suggested the mother make extra effort to have a wide gape on baby
before attachment and to hold him closely to prevent him pushing any of the
breast tissue out of his mouth.  And I've said I'll toss it to you for answers.

Re the 2 hourly feeding - it has been very hot here lately.

Thanks for the thoughts and many brilliant suggestions I'm sure I'll have soon.

Denise Fisher, RM,IBCLC, NMAA Counsellor