Just a wild guess:

<His weight gain has been excellent and he appears to
be thriving.>

Could this be related to overactive let down and "backing off" the nipple
to protect his airway from the "firehose effect"?

I should think it would be worth observing several feedings, and perhaps
acting proactively, triggering the MER by fingertip expression or a
little pumping, then waiting FOR A FULL 5 MINUTES for the reflex to
happen till the pressure subsides fully, before latching.

If he has acquired "backing off" or "pinching off" the nipple as an
aversive habit, it may take doing this consistently for every feeding,
plus adopting antigravity positions to break the habit, till his
"distrust" subsides to the point where he no longer feels he must be
defensive.

If this is the situation, it often goes along with oversupply. In this
situation I explain the "First Breast First" philosophy and the option to
begin using one breast for 2-3 feedings in a row, relieving the other
side only minimally for comfort and to lower the risk of plugged ducts.
The back pressure slowly begins to tamp the supply down enough that the
OAMER calms way down.

I have had a number of mothers successful with (gradually) eventually
going to all feedings in 12 hours on one side, the next 12 hours on the
other. I believe Dr. Newman even mentions 24 hours on one side and the
next 24 hours on the other.

"Lactoengineering" is certainly worth a try before thinking of anything
like craniosacral, etc.

Jean
***********
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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