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Subject:
From:
"Barbara Wilson-Clay,BSE,IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 29 Mar 1998 10:32:29 -0600
Content-Type:
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Why wouldn't a baby open wide in response to stimulation of the root, since
this is a normal infant reflex?  The reasons include:

#1  Depressed rooting reflex -- multiple reasons for this including
prematurity, neuro problems, illness, drug exposure.
#2 Mechanical damage to the TMJ (by forceps or some other birth related
trauma) which causes pain to baby when opening.
 #3 Aversive behavior -- baby is defending the mouth  because of aggressive
or painful oral experiences (some of which may have been unavoidable -- such
as intubations, suctioning of meconium)
 #4 The baby is protecting the airways because some sort of swallowing
problem overwhelms the baby's respiratory function during feeding.
# 5 Sensory defensiveness -- ie some neurological problems express
themselves as babies who find touch around and in their mouths intolerable.

#6 The most COMMON reason is POSTURAL.  Baby is positioned poorly so that
(among other structural issues) baby leads with the nose, not the chin when
reaching for the nipple.  In other words, baby is "rooting down" not rooting
up. Often this results when parents are taught to shove on baby's head while
bringing to breast, rather than drawing baby in along the torso, with
support at the shoulders. Tuck your chin into your neck and try to open your
mouth wide.  Now look up to where the ceiling joins the wall.  Try to open,
and you will find that SLIGHT neck extension allows the jaw to hinge freely,
promoting maximum gape.  If baby does not "over-shoot" the target, but has
to tilt up slightly to find the nipple, then the nice 90 degree gapes you
see photographed in Chole Fisher and Mary Renfrew's book, BESTFEEDING, are
easily achieved without digital manipulation of baby's chin.

This is not to say that a gently pressure on the chin doesn't sometimes
assist, but always we should ask ourselves WHY the baby isn't acting as we'd
expect a newborn to behave. To perform the digital manipulation is an
option, but it may not be the correct option in all situations.  I am sure
the person who posted does careful assessments, but I just wanted to make
the point to students on this list. No technique should be used without an
individual assessment which attempts to identify the basic reason why the
behavior is occuring.  Otherwise, we may contribute to a worsening of
feeding  problems (esp if sensory defensiveness or problems with breathing
underlie the tight jaw.)  Speaking truthfully, sometimes I look as closely
as I can and I can't figure out why a baby is doing something.  So if I
guess on which techniques to try, I watch really closely to see how the baby
reacts -- especially watching for motoric and autonomic stress cues.  The
timing of the occurance of the cues can give me hints.  If they don't occur
and baby is doing better, I know  I've guessed right.

Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html

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