Cheryl, et al...

This:  "These parents are yanking on the chin to the point where there is
redness and sometimes bruising." is so NOT what we are looking for when it
is suggested that parent's pull down on the chin.  While I understand the
general idea behind this technique I RARELY use it in my private practice
and NEVER suggest it over the phone - why?  Because parents frequently
underestimate their pressure which results in:  "And my problem is that I am
seeing more and more breast aversion by babies whose mothers attended the
class taught by one of my colleagues."

Bottom line - in my professional opinion, chin pulling should ONLY be done
one-on-one when:  Baby needs just a tiny bit of encouragement to open and is
taught by an experienced LC who can show the proper amount of pressure - NOT
PULLING! I don't think it should be taught routinely in a class setting
UNLESS the instructor is very good at distinguishing the whens to do it and
the HOWS. 

When I teach parents how to do this, I will actually show ON THEM (with
permission) how to do this using 2 types of pressure the overly firm pull,
where they promptly pull away from me  :)  and the gentle pressure where
they feel no instinct to pull away.  I do the same thing when teaching hand
position on baby with L-O; pressure with hand on back of head causes instant
reaction to push away...

>>"Some of my colleagues are convinced that babies' chins have to be pulled
down to obtain a wide gape and they are teaching it in class. They refer to
the Breastfeeding Answer Book as their resource."

This is a classic case of not using the technique only when needed but
assuming it is needed all the time.  If it works well for one it should work
well for all.  Overkill, imnsho.  Nice idea in theory, but not in practice.


I would suggest that you go back to the colleague in a positive way (if
possible), tell them (again) what you have seen and then re-read the passage
in BAB (with them) where it says in the side margin:  "Other ways to
encourage the baby to open wide are to say the word "open," have the mother
open her own mouth, and gently pull down on the baby's chin as he begins to
open."  KEY words:  OTHER ways  (not ALWAYS) and GENTLY.  In another
paragraph it says:  "If the baby doesn't open his mouth, or doesn't open
wide enough, the mother can open the baby's mouth wider by gently but firmly
pulling down on the baby's chin with the index finger of the hand supporting
the breast as he is opening. It is important to pull down when the baby is
opening because the baby's jaw muscles will be relaxed at that time.  If the
mother has a helper, suggest that the helper pull down on the baby's chin as
the mother is latching him on."  Again, key word:  Gently, and pulling down
AT THE TIME of opening - not when baby has his mouth closed and is NOT
rooting.  This is where parents NEED to be properly instructed on pressure -
too much can cause DAMAGE and PAIN.  An index finger supporting the breast
and trying to pull on the chin while baby is opening anyway isn't going to
have a lot of force - however, a helpers finger could - especially when baby
is refusing to open or is not ready to open.  

I wonder if this colleague would adjust her information if she were to see
firsthand the effects of the wording she is using...?  Bring her to see the
baby's who are being harmed and showing the effects.  You may also consider
speaking to whoever is in charge of content for the class and express the
concern you have for the physical harm you are seeing as a result of what is
being taught.  Breast aversion is obviously not OK, and it should be
documented and presented as an outcome of the particular information.
Bringing updated/new information on the asymmetrical latch may help.  We
learn so much these days - information is ever changing and growing...

Cheryl, I hope this helps to some degree.  I can see how frustrated you are
and hope that this gets figured out to the benefit of your babies...

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