Jo, Is the baby trying to recover from a birth injury like a cephlahematoma
or forceps brusing?  Sometimes these or similar injuries make for very tight
nursing patterns.  Mostly I just support the milk supply and reassure mom
that things will get better as baby recovers.  Try to keep the baby at breast
as much as nipples can tolerate it, but don't let mom suffer too much,
either.Let her have 24 -36 hours on a pump to heal up if nec. then try again,
or see if she can handle everyother feed on breast, etc.  If baby is flexed
at the hips this stabilizes the head and shoulders.  If head is thrown back
jaws will be tight and lips will pull in.  For looser lips flex the hips.

 An interesting irony about extreme reactions to stimuli is that they are
sometimes caused by low tone -- i.e. baby can't get good feedback because of
some (hopefully temporary) neurological issue.  Consequently, baby
over-reacts to things with exaggerated responses in order to 'feel' the
nipple in his mouth.  Could be baby has the opposite problem and is
hypertonic -- overwhelmed by so many stimuli that he too has exagerated
responses.  I look at body posture to see what baby does when not at breast
for clues. I still think LCs need more interaction with PTs and we need to
read the PT lit.

Could be something simple like the breast is heavy and not being well
supported and baby has to clench to hang on.  Could be baby is just latched
too close to nipple.  What shape are the nipples when baby comes off?  If
they are round then that's not it.  If they are shaped like an orthodontic
(sic) teat w/ a flattened edge and a crease across the tip, then baby is
mashing nipple with bottom jaw closure and nursing w/ a small mouth because
of basic posistioning and latch problems no matter how it looks to the
observer.  There is no one answer that is always going to be 'right' in these
situations.  Just lots of careful observation needed.

One of my favorite ref about positioning is Felicity Savage King's, Helping
Mothers To Breastfeed (Nairobi, Kenya.).  It gives permission to copy for ed.
purposes, and I've had slides made of some of the extremely intelligent
illustrations.  I've really seen light bulbs go on when I've taught
positioning with these illustrations.  I certainly hope the ILCA conf.
bookstore will stock this book again.  That's where I got mine, and I've
about worn it out.

Barbara Wilson-Clay, BSE, IBCLC
priv. pract. Austin, Tx