Debbie Codding posted about a tongue-sucking baby whose habit was impeding
latch-on.  I had a baby like this this past week.  In response to my queries
about the birth, the mother reported that the baby had been aggressively
suctioned.  I have a lot of faith in the robustness of breastfeeding and the
inborn desire to breastfeed that babies arrive with.  I always visualize a
baby who won't or can't nurse as a little person who is overwhelmed by
EVERYTHING that is going on.  I don't believe a few little things can
seriously impair bfg. When it fails, there are MANY things occuring.  If its
just the tongue, a bit of sucking on mom's finger helps get tongue moved into
right position.

In my client's baby's case, I think the tongue sucking may have been a
uterine habit. But it may also be a defensive move to block more intrusion
into an oral space that has felt (to the baby) violated, and is perhaps sore.
Additionally, Mom has non-elastic nipples.  Cord was wrapped around baby's
neck (Was there some oxygen deprivation?  Are we looking at some neurological
involvement with this tongue sucking?) Several boluses of fentanyl were
delivered during labor. She had an induced labor with pit and hard
contractions.  By the time I saw the baby, he was down 10% and totally out of
control with aversive behavior at breast.

My stategy is to gather enough info to see what all is involved.  If I
stopped with the tongue, and engaged in a lot of activity to mess with that,
I might miss the rest.  As it was, I determined that baby is prob. going to
require some recovery time and needs feeding in the meantime.  We worked with
positioning in tight flexion to give him postural advantages, used a silicone
nipple shield to coax him to breast and to move his tongue down, and used a
periodontal syringe to feed pumped milk at breast so he got an immed. milk
reward.  I showed mom how to use her finger to allow baby to get used to feel
of dropping tongue, but cautioned her to only do that right before latch-on
and only very gently for a moment so as not to make this baby more orally
defensive.  I told her he had to eat.  I taught her cup feeding, but told her
that if she didn't want to or couldn't get that together to bottle feed
pumped milk.  Nipple confusion doesn't have to be "fatal".  As babies
recover, you work on nursing technique.  Its optimal to try to keep something
occuring at breast even if baby isn't making it work perfectly. But options
remain open.  With calories, growth and recovery combined with what I call
"relaxed persistance" babies eventually nurse.  Often the perpetuation of
crisis mode becomes too stressful and mothers give up too soon, before baby
is realistically able. These are perhaps the babies in the old days who
wouldn't have made it.

I have another example. A beautiful Iranian client of mine who successfully
bfed her 1st child for 2 yrs. has a baby (now close to 2 mo) who has the
hugest cephlahematoma I've ever seen.  It is only just now beginning to start
to go down.  He hasn't had a suck worth beans this whole time.  I 've told
her to forget about the SNS, and all the rest and just pump.  She's been
bottle feeding.  He is finally starting to feed off bottles well.  It no
longer takes him over an hour to drink 2 oz.  So yesterday I told her to try
the SNS again with a nipple shield over it.  She sees that he perhaps CAN do
it now, and it has re-energized her to begin to work on re-establishing the
nursing part.  I call her weekly and just visit and encourage her pumping.

My point is, patience and time are part of healing. I no longer view all
issues as something I can fix in a visit. In those situations we focus on
 getting the human milk to the baby and saying we'll work together on healing
the nursing part as all are able.
Barbara Wilson-Clay, BSE, IBCLC
priv. pract