How do you know if your breastfed baby has fit and hold problems?

The gestalt method of fit and hold is only one part of the Neuroprotective Developmental Care (NDC) or Possums breastfeeding programs (under development as Breastfeeding stripped bare), but an important place to start. This version of the gestalt method of fit and hold for breastfeeding women has been available since 2016. I'm hoping that Breastfeeding stripped bare, the comprehensive NDC approach to breastfeeding and lactation, will be publicly available by the end of 2024. Key elements of the NDC breastfeeding work are also found in The discontented little baby book, and in my research publications, starting here.

Unworkable fit and hold is a very common problem for breastfeeding mother baby pairs. Unworkable fit and hold causes nipple and breast tissue drag and positional instability for both the baby and yourself.

Your baby may have fit and hold problems if he or she consistently shows one or more of the following behaviours with breastfeeding

• Frustration

• Difficulty getting on

• Fussing and fretting

• Back-arching

• Pulling off a lot

• Feeding for a time then 'refusing the breast' despite appearing to be hungry.

Unfortunately, poor fit and hold may also cause one or more of the following

• Nipple pain and damage

• Mastitis

• Low milk supply

• Marathon breastfeeding

• Excessively frequent breastfeeding

• Excessive night-waking

• Hunger despite feeding a lot

• Cry-fuss problems

• Inadequate weight gain.

In our world today, fit and hold problems are still very commonly missed. You might have been told that your baby's fit and hold is fine, but you and the baby still have problems from the lists above - in which case, the fit and hold most likely requires some more work, afterall.

Fit and hold problems are also still often misdiagnosed as

• Reflux or gastro-oesophageal reflux disease (GORD)

• Allergy

• Tongue-tie, lip-tie or restricted oral connective tissues

• Lactose intolerance

• Subtle cranial nerve, neurological or sensorimotor dysfunctions.

You can have fit and hold problems even if the baby has happy settled feeds. In this case, the fit and hold problems may be showing up as nipple pain, or excessively long or frequent feeds. The baby is not dialled up, but is also causing nipple and breast tissue drag.

Other babies may have normal weight gain but still show one or more of the signs of poor fit and hold, listed above, and will benefit from the gestalt method.

If you have concerns about your baby's weight gain or your own breastmilk supply, it is important to seek the help of your GP or a health professional. You can look for a local NDC Accredited Practitioner here.

Selected references

Douglas PS, Keogh R. Gestalt breastfeeding: helping mothers and infants optimise positional stability and intra-oral breast tissue volume for effective, pain-free milk transfer. Journal of Human Lactation. 2017;33(3):509–518.

Douglas PS, Geddes DB. Practice-based interpretation of ultrasound studies leads the way to less pharmaceutical and surgical intervention for breastfeeding babies and more effective clinical support. Midwifery. 2018;58:145–155.

Douglas PS, Perrella SL, Geddes DT. A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series. BMC Pregnancy and Childbirth. 2022;22(1):94. DOI: 10.1186/s12884-12021-04363-12887.