As with any interventions, there is a time and place where it is
appropriate and a time and place where it isn't.  Certainly we don't
need to literally get into the mouth of every baby we see.  On the
other hand, there are times when there is no other way to get the
information needed to begin to solve a breastfeeding challenge.  For
example:

   1. Mom's nipples are sore, or you hear strange noises as baby
nurses, or baby keeps losing the latch.  You have looked at the
baby's mouth to the extent you can without touching (depending on
baby to open wide enough on his own for you to see inside),observed
the latch, the feed and the shape of the nipple after the feed.
You've refined mom's techniques such as how she supports the breast,
how she holds baby, where she aims the nipple etc. etc. etc.  Still
the problem persists and you can't figure out why.  Feeling the
interior anatomy of the mouth as well as how the baby sucks may very
well provide the missing information.
   2. Baby has little oral response to being at the breast.
Sometimes gentle stimulation in the mouth can elicit the suck
response which baby can then transfer to the breast.  (I have yet to
figure out how to get a soft breast to stroke the palate or the
tongue like a finger can.)
   3. Baby has "taught himself" to suck on his tongue in utero.
Gentle pressing down and forward on the tongue until he positions it
there himself can help him get ready to latch.  A bottle or pacifier
would do the same thing, but which has more likelihood of creating
further problems?
   4. Digital Oral Assessment (we use DOE in communicating between
our LCs) can tell if there is a palate that is significantly flatter
or higher than the average.  If a baby won't open wide enough for us
to see the roof of the mouth, feeling is the only other option.

Hands-off observation is often enough to tell us what is going on
and should be the first approach, but when that doesn't "work",
gentle examination with a gloved finger may be the only other way to
get the information we need to make an effective plan to overcome
the challenge. Those LCs with minimal experience would do well to
read about oral anatomy and variations, perhaps feel models of
mouths with "normal" as well as variant features etc. before doing
much DOE.  The key is going it gently and with baby's "permission".
To do extensive "correcting" with a finger in baby's mouth of course
requires special training.
Winnie Mading RNC, IBCLC
Waukesha WI

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