I'm looking for more ideas than I got from my LLL Leader's list, please forgive
the double posting for those of you on both TLC and Lactnet...

First baby, born at 7 lbs, 2 oz.  At four weeks, she was 9 lbs, 11 oz. Baby is
now 4.5 weeks old. Baby looks healthy and alert, has quite a few red dots on the
face (those pimply things that many newborns seem to have). Birth was almost
unmedicated, Bradley coached with a doula but mom did use some Nubain at some
point in her 25 hour labor. Meconium was in the amniotic fluid and baby was
suctioned at birth and gavaged the next day.

Baby makes a smacking sound and appears to break suction. She does it more in
the initial part of the feeding, does it more when she's hungrier and all the
time if mom tries to nurse lying down. Lips appear to be flanged out most of the
time. I observed her upper lip curling in once but baby corrected it. Mom was
able to simply remove baby from the breast without using a finger to break
suction and apparently that is typical. I observed the tongue coming out to lick
her lower lip while baby was awake. I could not see the baby's tongue over the
lower lip while nursing but I wasn't  seeing more than I could see without
touching the mom. Baby seems to opening wide but at the corners of her mouth
there is some opening. On my couch mom did not have the baby tucked in well but
at home she uses a nursing pillow and understood what I meant right away about
staying tummy to tummy.

Baby had a cold last week and I observed her to be snuffly when nursing. I
mentioned she might be breaking suction to breath. Mom said that when baby was
sick she seemed to clear the mucus while nursing by sniffing the mucus up and
then swallowing it.

She experiences some nipple soreness on the days when baby nurses a lot. Her
nipples look fine and she is using Lansinoh now. Mom reports not being engorged
at all and does not feel letdowns. I thought that and the normal stools
precluded overactive letdown-foremilk/hindmilk imbalance issues. But I know how
much I don't know!

Baby did not do any smacking in the hospital. This started a couple of days
after coming home. They are using pacifier sometimes. I explained on two
different occasions why this may be a problem.

Baby nurses for relatively short feedings (10-15 minutes per side) but stools
sound fine in terms of consistency and color. They come out with a sound often
but I experienced that with my children and think of that as normal.  When baby
is gassy she tends to arch backwards and stretch her legs out. Mom has
eliminated many foods from her diet, including major sources of dairy (not
reading labels for small additions of whey, casein, etc). Baby rarely burps.

Mom is sometimes giving homeopathic colic tablets or Mylecon drops. She takes
several individual vitamin supplements and some Chinese herbs. Baby is not on
any supplements.

I counseled her on general fussy baby management issues, since baby is having
almost nightly fussy times and is awake a lot at night. I consider these fairly
normal and we talked about baths, sling, the massaging she's doing, books to
read. We discussed that the smacking may be a variation of normal and how
wonderful her daughter is doing.

My goal is to identify a reason for smacking and to enable mom to nurse lying
down. Is the smacking and frequent lack of strong suction/attachment a variation
of normal in light of good weight gain. I understand that positioning lying down
is not always easy with a newborn but it nags at me that the smacking is present
in that position.

Sharon Starkston, LLLL, Hinsdale/Clarendon Hills, Illinois, USA
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