Last week I saw a new aspect of clicking I have not seen before and wondered
if any of you would have any thoughts on the cause.  Baby is a six week old
girl born at 3250g, discharged at 3 days weighing 3200g and now weighs 4480g
(i e thriving) on exclusive breastfeeding.  Labour/delivery was quick and
easy, no forceps, no vacuum, baby was not suctioned after delivery or later.
She is chubby, alert, calm, smooth skin, clear nose (i e no sensitivity to
small Qx dairy in mother's diet). No oral thrush.  Mother is concerned that
the baby "clicks" during breastfeeding.  Mother has average/large breasts,
soft, lactating well, normally protruberant nipples (very average, not long,
not short) and nicely elastic areolar tissue.

The baby breastfed very effectively (easy swallowing, good milk transfer)
but the clicking lasted throughout the feeding and was so pronounced that
the baby seemed to be fairly bothered by it (a little jarring with each
depression of the jaw as it happened which made the baby blink!).  Suddenly,
without warning, the baby gagged.  Mother tipped her over (as if she
expected her to vomit, although she didn't) waited a minute or two and then
the baby resumed nursing quite happily.  Mom says this happens fairly often.
Baby will not nurse to sleep at the breast, nursings are fairly short (5 -
10 mins) and baby has no dummy/pacifier, nor does she suck fingers/thumb -
mother rocks her so she can go to sleep.  Mother described sore nipples in
the early days, but there is no pain or nipple chiselling now.  We worked on
compressing the breast tissue behind the areola, and using a rapid arm
movement to enable the baby to take a larger mouthful to no avail - baby
would allow the extra tissue to slip out of her mouth and then carry on
clicking!

Obviously the clicking by itself is not causing a breastfeeding difficulty
(the baby thrives) but I wonder if it is a symptom of a hair-trigger gag
reflex - as if the nipple going to the back of the throat will stimulate the
gag, and the baby compensates by drawing the nipple only half-way in to the
mouth, thus losing suction with every downward movement of the jaw, which
results in the click.  It is the gagging which really bothers me, I have
never seen this before. Is it a problem? A symptom of something *else*?  Any
thoughts, anyone???

Pamela Morrison IBCLC, Zimbabwe