Dear Betsy,
I am finally responding to your post of 27.10.95 in which you asked
questions about our clinic. I apologise for the delay. Life is rather hectic
right now with work commitments.
Firstly, Robyn (LC) and myself (Speech Pathologist) work together with
mothers and babies. If we suspect that an internal examination of the baby's
mouth is needed to help with diagnosis, I usually do the honours, although
Robyn is equally skilled in this area. We do try to keep internal
assessments to the minimum, though.
What I look for during such an assessment is:
1. The shape of the baby's palate. In many instances there is a marked notch
or concavity in the anterior or posterior section of the baby's hard palate.
There are those who present, of course, with palate shapes that could best
be described as fascinating!!
2. A basic idea of how the baby likes to suck with my finger in the notch
and then gradually and gently placed back at the juncture of the hard and
soft palate.
3. Any other lingual aspects noted that may assist with identifying the
problem: eg. tone, shape, gag, other lingual movements etc.
Such an assessment is then considered when we observe the baby suckling at
the breast. We are then able to give the mother some indication as to what
is happening during suckling, why her nipples come out mis-shapen and the
cause of the pain.
We find that mothers, once armed with this knowledge of their situation, are
well able to respond to various proceedures to allow more breast tissue into
the baby's mouth. This is the basic consideration in many cases.
Shaping the mother's breast so that the nipple edge is compressed in the
same line as that of the baby's mouth is necessary to start with. Sometimes,
it may be necessary to maintain this shape and firmness after the baby has
attached in order to keep the breast tissue in the mouth if the baby has a
receeding chin or poor negative pressure.
Wide open gape over the mother's nipple is also crucial and we find we have
to show mums how to tempt the baby with constant running of the nipple over
the baby's mouth until the gape is wide enough for attachment. We then
describe the mother's movement of bringing the baby to the breast with
nipple aimed at the hard palate, as RAM (rapid arm movement) as the baby
tends to close quickly.
Further adjustments may have to be made with:
1. body positioning to bring in the jaw and move away the nose from the
breast. (rotation of the hips, for example)
2. Jaw pressure if biting. We often massage the tempro mandibular joint or,
in ocassional cases, pull down on the jaw.
3. checking the line of the baby's body to see slight extension of the
baby's head to accept the breast.
4. checking the tension of the mother's wrists and shoulders and show her
how to brace using legs and if necessary, pillows.
Each case is so individual and we have resorted to using many different and
imaginative proceedures in order to encourage babies to suckle, as I'm sure
you do too!!! I think I must state too, that out clinic receives babies with
severe sucking disorders. We often joke that we are the "dead end" clinic as
we mostly receive cases that have "failed" in other attempts and our mothers
come in saying, "this is it. If I don't get any where here, I'm weaning!"
Hence we justify our interventionist proceedures which are broadly based on
methods used by Chele Marmet.
Our use of traditional, straight, long teats is with babies who simply do a
"terrible job" at the breast, despite everyone's best efforts to have them
attach correctly. Their movements are poorly co-ordinated and their mother's
nipples really do need a chance to recover. In such cases, we find that
while a mother can rest her nipples for a few days, she can pump and feed
EBM through such a teat, the baby can learn the long drawing jaw movement
needed to milk the breast. Often, these babies have to be trained to use
this teat also! We frequently get better results using this style of teat
than we do if we try finger feeding, which can prove cumbersome to the
mother also. Our success rate using these teats is very good, and since
trialing them so successfully, we maintain that if the artificial teat can
go back far enough in the baby's mouth you can, in many instances, eliminate
nipple confusion.
Sorry about being so long winded, Betsy, but I hope this gives you an idea
of some of the things we do in our clinic. When we first started out
together, 2 years ago, we felt we were jumping, feet first, in the deep end.
Our cases have always tended to be difficult, and it's heen through trial
and error that we've developed our proceedures. We feel we are constantly
being challenged by our clients' problems and in the past have sometimes
felt isolated. Lactnet has helped us considerably in this. The feeling of
being part of an international network is very reassuring and the learning
curve is rocketing ever upwards.
ANNE BOVEY AND ROBYN NOBLE, BRISBANE, AUSTRALIA.
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