What I see is the baby is tight toned all over. He holds his arms tight, 
his fists tight, his mouth tight. He may latch ok but if you look at the 
corner of the mouth, it is a V where the lips touch at the corner, not a 
U with relaxed lips. They often arch backwards both at the breast, on 
the baby scale, and when changing the diaper. It takes the full feeding 
before baby relaxes his arms. You can gently pull on the arms while he 
is breastfeeding and there is tension or you can not gently move the arm 
easily. They are often fussy, before feeding, after feeding, and the 
weight gain is good. Sometimes the mouth/jaw is so tight that mom has 
sore nipples. You see a white line around the lips with latch on. And 
the lip muscles are very tense looking.

Do we even know how this happens? I have heard, but have no proof, that 
epidurals cause this. I do believe Linda Smith talks about how even 
normal trauma as the head moves down the birth canal can affect the 
muscles and nerves in the head and face. For more information, read 
Impact of Birth Practices on BF.

The only thing I have seen really work to "relax" these babies is 
craniosacral therapy. The practitioner that I refer to says that the 
reflux stuff is really impaction of the nerves to the stomach and she 
works on those and stops the stomach issues. She feels the nerve issue 
is the cause, not that the reflux is the cause.

Whatever the cause, these babies are very irritable and have 
difficulties organizing themselves to feed. The arching at the breast is 
often the baby not being able to get started feeding. They often can 
feed well and take in nice amounts once they are on and start sucking 
appropriately. If you watch them, you see it takes them some time to 
figure it out. Even when they are 100% breastfeeding and not getting 
bottles, they just seem slower to organize their mouths and sucking and 
get it going. And this goes on and on, some feedings are better and some 
worse. I tell mothers to realize the baby isn't rejecting the breast as 
they think but rather the baby can not organize itself to feed properly 
and needs mom to help guide him.

Kathy Eng, BSW, IBCLC

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