- Sleepy baby: A few possible reasons that this may occur are medical issues; the baby may be overstimulated; or your milk may be "coming in." Although it is essential to determine why your baby is sleepy, it is equally as important to work on waking methods.
- Weak suck: Typically, the breast continually comes out of the baby's mouth, particularly when the mother shifts even slightly. Also, milk leaks out of the baby's mouth while he is nursing. Overall weakness can be a contributing factor, or the baby may have respiratory or endurance problems. Both assisting the baby to have a stronger suck and increasing the flow of milk are the keys to changing a weak suck. Aside from ensuring that the baby's latch-on and positioning are correct, cheek and jaw support are essential.
- Poor initiation of sucking: There can be many obvious reasons for this -- premature, jaundiced, or neurologically-impaired babies may have difficulty. Quite often, a baby will display an excessive rooting reflex. Regardless of what the issue is, it is critical that underlying problems receive treatment. Managing excessive rooting is achieved by giving the baby's body firm support and controlling the head through proper positioning. It is also important to assist the baby with mouth closure by firm jaw support.
- Biting, clamping or clenching response: Make sure that the baby is very well-supported as this often stems from overactive muscle tone. Some treatment methods include "mouth play," or giving the baby a lot of oral experiences (feeding, touching) to increase awareness of what the mouth can do. Stimulation on the face will also help to achieve this goal.
- Excessive tongue-tip elevation: The tip of the tongue is raised up against the hard palate, just behind the area of the mouth where the sockets of teeth should be. In this case, putting the breast in the mouth is problematic.
- Tongue protrusion or thrusting: One treatment includes applying firm, downward pressure to the tongue to push it down and out. Another technique is to walk your fingers back on the tongue to achieve the same goal.
- Lack of central grooving of the tongue: The best method of treatment is "proprioceptive input," or teaching the sensory receptors in the tongue to respond to a stimulus. This involves placing a downward pressure at the midline of the tongue and slightly stroking forward. A firm, straight nipple may also help, so a nipple shield may be recommended.
- Excessive jaw excursion: Babies will display disorganized sucking at the breast with a loss of suction and a repeated need to "relatch." To help the situation, it is necessary that positioning is correct and that the mother gives the baby jaw and cheek support.
- Inadequate mouth opening: There can be many reasons for this, but typically relates to the baby's state of alertness or a clenching jaw. Some methods to help the situation may be: adjusting the baby's state; beginning the rooting reflex; helping to open the mouth; preventing jaw clenching.
- Gags: The best method of treatment is desensitization.
- Low or high muscle tone: Babies are described as "hard to hold" or they "arch away from the mother."
Premature Babies and Associated Sucking Problems
If your baby is premature, you may notice that he has a combination of sucking issues. The most common are:
- Disorganized or inefficient sucking patterns
- Weakened lip seal
- Impaired tongue shaping or movement
- Weakened stability of the inner cheek
- Trouble synchronizing the suck and swallow with breathing
- Poor ability to awaken and to stay alert at the breast
- Low control of posture
One commonly seen complication in premature babies is Infant Respiratory Distress Syndrome (RDS). This can have an negative impact on feeding as well. Babies with RDS have difficulty synchronizing their sucking, swallowing, and breathing. They cannot withstand long feeds and tire easily. As a result, the baby does not have an adequate intake of nutrition.