Does your baby suck?
No really--do they? But like, in a good way? File this under questions only lactation and feeding professionals will ask you about your new baby!
Why do we care so much about suck? Suck is probably baby's most important reflex after birth, allowing them to feed themselves. And a strong suck isn't enough, we need to know if the suck is functional--aka, will it transfer milk? If your baby sucks at sucking, we may have an issue or two to address!
So how can I know if your baby sucks in a good way? Part of every one of my lactation visits with baby is an oral exam or assessment. It's part of every visit because suck can change over time, either with interventions or on its own as baby learns and becomes more efficient. Here is what you need to know:
An oral assessment is a way to help me understand how all the parts of your baby’s mouth are working together…or not. I will assess your baby’s palate, gums, & tongue both by sight and by feel. I will also ask for your help to take photos of the structures in baby’s mouth. An oral assessment is DESCRIPTIVE: it is a way to communicate to you and to other providers what I have observed. If I am concerned there are structural or functional issues, we will talk things through and I may refer you on to another provider. The assessments I use if I am referring you on, the Hazelbaker Assessment Tool for Lingual Frenulum Function (ATLFF), and the Assessment Tool for Lingual Frenulum Function with Scores (Martinelli et al) are tools that have been extensively studied and found to be valid and reliable descriptors of oral function.
I will start by washing or sanitizing my hands and putting on gloves. I will greet your baby–although they can’t see me smiling behind my mask, I hope they can hear it in my voice!
I will gently stroke your baby’s lips to see if they extend the tongue to “greet” me and tickle the upper lip to see how high their tongue lifts. Some of this may also be observed at other times during our appointment, such as when baby cries.
If baby seems ok with me being near the mouth, I will offer them a finger to suck on. When they are sucking, I am feeling the upper palate and the motion of the tongue, plus testing the strength of the suck.
After a bit of sucking, I will turn my finger over in baby’s mouth and feel along the lower gum to see if the tongue follows.
Finally, I will look at both the lingual (tongue) and labial (lip) frenula. We ALL have these points that tether our oral tissues; the issue is that for some people, the frenula are short, tight, or in a position that prevents proper functioning of the oral structures, impairing milk transfer and causing pain to the nursing parent.
First, I will both look at and feel the frenulum on the upper lip by flipping the lip up gently. Please know many babies don’t love this part of the exam! We will take a photo of the lip, then move on to the tongue.
I will use two fingers to gently lift baby’s tongue toward the roof of their mouth so I can see the lingual frenulum. Most babies don’t like this part of things, but it is important! I will be looking at the length and width of the frenulum, seeing where it connects to both the tongue and the floor of the mouth, feeling to see if it is flexible or taut, and then getting a picture.
Typically at this point, baby is ready for the second “side” or the rest of their feeding as a reward and thank you for cooperating with me while I poke around their mouth!
The oral assessment tells us so much about how baby is doing their most important job, far more than a simple glance in the mouth ever could. If you wonder about what I'm seeing/feeling in an assessment, please ask! I love parent questions and am so happy to help you understand why having your baby suck is a GOOD thing! :)