Gonneke asks what, in our opinion, is the cause of arching or over-stretching when being offered the breast **in the first week of life**. In the first week, I think it is almost always a result of forceful so-called help, and secondarily a result of vigorous suctioning. We don't routinely suction babies here, happily. Rarely it may be due to a fractured clavicle, or torticollis, but poor help in the first couple of days is by far the most common cause I see. It is also the easiest to deal with, by giving the initiative back to the baby through skin-to-skin on mother's unclothed upper body, with mother lying flat on her back. It almost never takes more than a couple of sessions before there is great progress and a much happier mother and baby. Arching and general tension at the breast in an older baby, in my experience, starts more insidiously and is harder to deal with because the longer a problem exists, the more difficult it is to solve. There may have been small difficulties with latching from the start, but things seem to go sort of all right for weeks, even a couple of months, before mother calls, exhausted, distraught over her obviously unhappy but rapidly growing baby. Sometimes mother has tendonitis in wrists and shoulders from the bizarre positions she has resorted to in order not to elicit the arching, or to hold the baby close enough to complete a feed. The prime feature is the mother's lack of self-confidence because she is getting very little positive feedback from the baby, and nearly all their waking time together is spent physically struggling to get baby situated for a feed. The babies are high-tone, and arch very exaggeratedly and with little or no provocation, usually only to one side. Some of them spit up a lot, but that is rare. Typical for these mothers is that they never report that breastfeeding was going excellently, only all right, and then it deteriorates as baby grows. A lot of them report jaw-clenching latch at the start with marginal improvement as milk supply builds. The well-child follow up system here has no scheduled contacts with babies from the age of about ten days, to six weeks. Mothers go home on day three or thereabouts, and there will be one home visit by the health visitor, at some point in the first ten days after that, and then it is up to the mother to make contact if she thinks she needs it. The baby may be asleep during the entire home visit so is never observed feeding. IME the mothers who really need it are the least likely to get in touch. By six weeks things are really rocky, although since these babies are usually gaining weight like gangbusters and weighing and measuring and a once-over by a doctor are the focus of the six week visit, their unhappiness is trivialized to the tune of 'it's normal for babies to cry some every day'. By the time they come back to me, after a couple of months, they often have visibly misshapen heads, flattened on one side because they are always turning the same way, and the breastfeeding problems are extremely pronounced on the side requiring the baby to adopt what is for him an unnatural and difficult, if not impossible, position. There is a theory from Germany, about a syndrome abbreviated as KISS which on a Norwegian website about the condition is translated as 'Kinematic imbalance due to suboccipital strain' but when I translate the German term I get 'upper cervical vertebra-induced symmetry disturbance'. It is gaining credence here, fortunately, because without recognizing that this is a physical problem, it is impossible to get help. When I see these features I have now stopped trying to help with positioning until baby has been seen by an osteopath, specially trained physiotherapist, or craniosacral therapist. And, wonder of wonders, there are such people in my community, and the treatment works. The baby starts relaxing more and feeding better and there may not be any need for further breastfeeding support. This is because it isn't a breastfeeding problem, it is a physical problem which manifests itself very visibly during feeding. I think that's why it has taken time for it to be recognized at all. I know I have worked with mothers in the past whose problems were attributed to a pathological relationship to the baby, and the relationship was merely a consequence of the baby's physical inability to lie relaxed in mother's arms at the breast. How sad is that? Jane Kershaw and Kathy Eng both mentioned some of the same features that are listed as possible causes of KISS. From the Norwegian website, I quote: babies born by CS, forceps or vacuum extraction are at higher risk. It's safe to assume that how we are born, matters in the long run too. In places with very high intervention rates, more of these cases will be solely attributable to the intervention. But in communities with lower overall rates of birth intervention, we should keep in mind that whatever necessitated the intervention could also be a contributor to the problems after birth. A baby with an abnormal body flexion will not traverse the birth canal as easily, and we simply don't know whether this plays a role. While we work to improve the circumstances of birth for all babies, we should also do whatever we can to help babies whether or not we know the cause of their troubles. Sometimes in interdisciplinary discussions I have gotten the impression that it is more important to be able to lay blame somewhere, than to solve the problem at hand. The NICU might criticize intrapartum care for a baby's condition at birth, and the birth attendants would argue for antenatal causes, and the lactation brigade would like to emphasize separation of mother and baby as a cause of the resulting breastfeeding problems, and when they go home, the well child care system is peeved because the hospital didn't do a good enough job while we are exasperated at their failure to follow up. Even if all of us are right, the mother and baby aren't any better off until we help fix it. *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html Mail all commands to [log in to unmask] To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or [log in to unmask]) To unsubscribe: unsubscribe lactnet or ([log in to unmask]) To reach list owners: [log in to unmask]