Busting myths about babies who fuss a lot coming onto the breast, during breastfeeds, or at the end of breastfeeds
Some things might seem to help as time passes, when in fact it's the passing of time itself that helps
Remember that some things can seem to help over time just because many problems gradually sort out for you and your baby as baby grows, regardless of what we do.
This is why the most reliable kind of research studies compare the effects that a particular intervention has, with the way time passing without that intervention affects the baby or parent.
But your helpers might sincerely believe that the problem's improved because of the exercises or other interventions they've recommended. It's known in science that when we expect to see change, we are much more likely to see that change. Scientists know that the neurobiological effect of expectation is powerful, and measurable, and affects both parents and health professionals alike.
The other big problem that we strike in trying to make sense of what works, is that many, even dozens, of different suggestions and little interventions are usually made in the one consultation for a problem as complex as breastfeeding difficulties. It's very hard to know what part of the consultation has actually made a difference, without careful research which controls for each element.
For instance, a lactation consultant or bodywork therapist might diagnose restricted oral connective tissues in the baby's mouth along with various other infant neuromuscular dysfunctions, which she believes (due to her training in oral myofunctional therapy) is causing the fussiness with breastfeeds. The lactation consultant might be absolutely convinced that the exercises she teaches a mother to do on her baby is why the breastfeeding improves over time.
But the lactation consultant also offered many different pieces of advice in that consultation, and one of these could be what is actually making the change - or it could be that the mother and baby are just working things out together themselves anyway, as time passes!
Misunderstandings about why a baby might fuss a lot at the breast
| Popular explanation for why your baby fusses at the breast | Why this isn't accurate | The NDC or Possums approach |
|---|---|---|
| Baby can't open up her mouth wide enough before coming on. Needs bodywork therapy and exercises for temperomandibular joint and other oromotor tightness. | Your baby doesn't need to open up her mouth wide to come on to the breast. Trying to get nipple to nose alignment and waiting for a wide gape before bringing baby on can actually dial babies up at the breast. | Bringing baby on any old way, mouth over nipple, is fine. It's what you do next once baby is on, with your micromovements, that matters. Find out more here. |
| Baby has a shallow attachment ('nipple feeding', feeding from end of nipple) and can't open up her mouth wide enough. Needs bodywork therapy and exercises for oral connective tissue restrictions and joint and muscle tightness. | What appears to be shallow attachment can be quickly changed by experimenting with micromovements, once you know how. It is not a problem of your baby's function or anatomy, but of how your little one is fitting into your body. | You can find out more here. |
| Your letdown is too strong. Your baby has to clamp down to control the flow. Lie back to let gravity weaken the letdown. | Letdowns are highly variable, and tend to be strongest at the beginning of a feed, due to higher milk volumes (although some breastfeeds don't transfer much milk at all, which is normal.) There's no evidence to suggest that some women have stronger letdowns than others. Gravity doesn't impact on letdown, but lying back definitely does help with positional stability. Babies don't clamp down to control the flow. | In the first week or two, newborns might pull off and splutter a bit with letdowns (which doesn't mean your letdown is too strong). But usually babies pull off the breast because they are not in a stable position, which means they have difficulty suckling in a comfortable and coordinated way. They may appear to have shallow attachment and to be 'nipple feeding' with mouth closed on the end of the nipple because of the way they are fitting into your body, which can be changed. |
| Your baby isn't getting enough milk and is frustrated. | When positionally stable, babies who are needing more milk suckle for long periods. That is, when baby isn't getting enough milk, women typically experience what is called 'marathon' feeding. Babies typically dial up and pull off the breast because they're not in a stable position. Babies are biologically primed to suckle at the breast when they are hungry, not to pull off. | For help with positional stability, start here. |
| Baby has a tongue tie or other oral connective tissue restrictions, and requires bodywork therapy or frenotomy. | Classic tongue tie can cause breastfeeding problems, in particular nipple pain, and may require a simple scissors frenotomy. There is no evidence linking oral connective tissue restriction with fussy behaviour at the breast, air swallowing, gut pain, reflux, sleep, or developmental problems. It's now clearly proven in the research that there is no anatomic or functional basis to diagnoses of 'posterior' tongue tie or 'lip ties'. | Babies fuss at the breast due to positional instability. There is a health system blind spot concerning fit and hold, and often babies with positional instability are misdiagnosed as requiring frenotomy or bodywork exercises. For help with positional stability, start here. |
| Baby's tongue mobility is restricted so he can’t get the initial seal, or can’t draw up breast tissue. Or baby has a short tongue. Frenotomy or bodywork therapy and exercises are required. | The posterior tongue creates a seal against the soft palate, but can't be visualised in the clinic and is not connected to or affected by floor of mouth fascia. This explanation misunderstands the biomechanics of infant suck in breastfeeding. | You can find out about how babies suck in breastfeeding here |
| Baby has retrognathia (small chin). | Mandible size is highly anatomically variable in our babies, and changes over time. | Chin size is just one of many anatomic variables that are flexibly compensated for when making fit and hold as good as it can be. The problem is not chin size, but how fit and hold is applied. |
| Baby has torticollis. | A true congenital, anatomic torticollis, or torticollis related to fibrotic injury of the sternocleidomastoid muscles requires fit and hold compensations. However, this is rare. Most torticollis in babies is functional, and doesn't impact on baby's capacity to turn their head or move their head and neck in breastfeeding. | Good, stable fit and hold in breastfeeding is the most effective thing you can do to help your baby with symmetric use of her sternocleidomastoid muscles, and repair of tightening on one side. You can find out about misunderstandings about torticollis in babies here. |
| Baby has high palate so tongue can’t create seal or can’t draw up enough breast tissue. | The tongue doesn't create a seal against the hard palate. Palate shape and height is highly anatomically variable in babies, according to genetically determined shape of the face. It is not shaped by the tongue movements, or lack of them, in utero. | Palate shape and height is just one of many anatomic variables that are flexibly compensated for when making fit and hold as good as it can be. The problem is not the palate, but how fit and hold is applied to optimally fill baby's mouth with the nipple and breast tissue. |
| Your nipples are flat. | Breastfeeding babies require a mouthful of breast tissue, which includes the nipple. Nipple heights are highy variable, and it's not helpful labelling a woman's nipple as flat. | Often, the problem is positional instability and can be solved with the right help. Sometimes, the health professional assisting you might suggest that experimenting with a nipple shield. |
| You’re anxious and the baby is picking up on your anxiety. | I have the view that this is an inappropriate thing for anyone to say to you, because it not only misunderstands the many factors that are usually interacting together to cause your baby to have a pattern of dialling up, but also blames you. I know how incredibly hard women are trying to get things right, in the context of rampant health system blind spots and conflicting, unhelpful advice. Your baby responds to behaviours and also to mechanical factors, not to your upset feelings, which are a normal response when your baby cries a lot. | It's normal to be very upset when you're baby is fussing a lot at the breast. Our upset feelings can become even worse if the baby has developed a conditioned dialling up at the breast. But no matter how upset and worried they're feeling, most women can find how to help their baby come onto the breast without fussing by working through this chapter, or by seeking the help of an NDC practitioner. I also recommend looking at the section in Possums on Caring for you, starting here. |
Summary
You will see that typically, problems with fussiness at the breast are caused by how your baby is positioned at the breast relative to your body. Sometimes that turns into a conditioned dialling up.
You may need skilful help by an NDC practitioner to sort these things out, although you might also find the self-help materials, available from here, are all that you need.
