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Proper attachment of the baby to the chest. What it is?


When I start talking about right and wrong attachment of a child to my chest, I often hear the following phrase: “What do you mean? Is it possible to suck the breasts incorrectly? ”More often than not, I hear this question from medical staff. Especially, it upset me at the beginning of my work as a breastfeeding consultant, when I heard this phrase from the medical staff of the maternity hospital ... Attaching to the chest is a very delicate thing. 20-30 minutes after birth, the newborn has a desire to suck, he begins to look for the breast, opens his mouth, makes nodding movements with his head, tries to crawl towards the nipple. And at these moments, when the child’s instinctive sucking activity is still not spoiled, only 30% of children take their breasts correctly and suck productively! The rest must be corrected, helped, breastfeed several times before the attempt can be called successful. In most Russian maternity hospitals, no one puts a child after the relaxation phase. No one waits for the baby to come to his senses and show search activity. Immediately after the birth, the umbilical cord is cut, the mother demonstrates and is taken to the "treatment". At best, the baby will see the mother in 2 hours, and most likely in 6-12 hours. Mom usually says that the baby is resting after giving birth, now it’s not up to sucking. At this time, the baby is usually 1-2 times given water or a mixture of nipples. This is called pre-breastfeeding and leads to the formation of the habit of sucking not the breast, but the nipple. Doctors and nurses usually protest and say, they say, what a nonsense. Nothing wrong. Then he will suck the breast, not going anywhere. Coming to the postpartum department, I constantly meet children for 2-3 days of life, who do not try to suckle if she gets them in their mouths. The kid demonstrates active searching behavior, opens his mouth, turns his head, sometimes shouts. When I try to attach it, he opens his mouth wide, but does not try to start sucking. It happens that the child immediately starts crying as soon as the breast is put in his mouth. Very often there is a situation when a child ceases to open his mouth wide when searching behavior. This is the behavior of children who have had the experience of sucking nipples or pacifiers. Such a “wonderful” picture is often observed: a mother sits above a plastic maternity hospital bed, admires a peacefully sleeping baby, sucking a pacifier, on which is written “I love you, mama”. (Lately such pacifiers are very often found in Moscow). I ask my mother if the baby sucks her breasts, to which the mother replies that she tried to give a couple of times, but he somehow didn’t really ... The second day after the birth ... Usually, when I start my mother to tell that if you periodically give the baby to suck the bottle with With the nipple, the baby can refuse the breast, the mother says: “Yes, it is easier to suck from a bottle. And here (in the maternity hospital) there are also holes so big. ”Meanwhile, the matter is not at all in the holes and in the ease of sucking. The hole can be made very small. The thing is that when sucking nipples, the baby makes fundamentally different movements. It is easier to suck from the breast, because helps reflex oxytocin, which reduces the smooth muscle cells around the lobes of the gland and pushes milk into the duct. Milk is injected into the child’s mouth thanks to this reflex. Baby, having experience sucking nipples, is also trying to suck breasts. It is almost impossible to extract milk from the breast if sucking it as much as the nipple. The child begins to get angry, refuses to breast, screams. Mom is upset and to calm her, gives the baby a bottle or pacifier, which he immediately begins to suck. Here it should be noted that the baby needs to suck to get rid of discomfort. The baby is like sucking. If he is used to sucking the nipple, he will suck the nipple. If he is used to sucking her breasts, he will suck her and calm down with her. If he gets used to calm down with a pacifier, he will calm down with her. It is widely believed that if a child is given a breast first, and then a bottle, the child will not give up the breast. Many mothers also believe that if you give a child only water, tea or juice from a bottle, the baby will not give up the breast. In fact, in order for the baby to begin to refuse the breast or to spoil his attachment, it is not at all important when and in what quantities he sucks the nipple or the pacifier. There are children who need to suck the nipple 1-2 times for problems. There are babies who “suddenly” begin to act up at the breast in 2-3 months. There are children who are happy to suck all that they are given, but begin to reduce weight gain. The World Health Organization speaks about this issue in its bulletin on infant feeding in the first year of life: “In a normal newborn, the reflexes of breastfeeding are already quite strong at birth. Indeed, the practice confirms that some babies born at the 32nd week of pregnancy weighing only 1200g are able to suck breast effectively even before they learn to suck from artificial nipples, the difficulties with which were explained by hypoxia and bradycardia in premature babies. However, these crucial reflexes may be weak, or absent altogether in cases of too early abortion or in children with extremely low birth weight, as well as in sick children ... ... However, the most common cause of the reduced effectiveness of these reflexes is iatrogenic: use of sedatives or painkillers drugs during childbirth, intervention in the learning process after childbirth. The instinctive movements of the child must be fixed in the correct behavior in the postpartum period. The use of other oral objects, the nipple or pacifiers during the period immediately after birth may create a condition for the occurrence of other oral movements in the child that are unacceptable for breastfeeding. ... For the successful development of breastfeeding factors that reduce the duration, effectiveness and frequency of suckling the child should be eliminated in any available way. These factors include limiting feeding time, feeding on a schedule, uncomfortable position, using other oral objects, getting other liquids such as water, sugar solutions, vegetable or dairy products. ”The value of proper attachment is huge for the formation of full lactation from the mother for long and successful breastfeeding. Only with the right attachment does the child stimulate the breast for adequate milk production. Only with the right attachment can the baby suck the milk as much as he needs. Only the right attachment does not cause the mother any discomfort during feeding and only with the right attachment it is never necessary to interrupt the feeding due to painful sensations, since they are simply not there. What does the correct attachment of the child to the breast look like?
The child must grab the nipple and areola with an energetic “free-running” movement of the head lifting the breast, and then, as it were, applying it as the breast moves down into a wide-open mouth, with a lowered but not protruding tongue under the breast. It is necessary that this grip be complete and deep enough so that the nipple is in the baby’s mouth almost at the level of the soft palate, i.e. The nipple together with the areola should actually fill the entire oral cavity of the child. Such a grip requires a very wide mouth opening, and if it does not work right away, you can help the child with a nipple on the child’s lower lip, which will cause a reflex lip movement and mouth opening. Often the first reaction of a child to the mother’s breast will be its licking and only then capture. With the right grip on the child’s breast, a wide-open mouth is preserved, on the side it can be seen that the lower lip is completely turned out (it is pushed out by the front edge of the tongue lying on the lower jaw). Areola completely enters the child’s mouth if it is small. If the areola is large, then its capture is almost complete, asymmetrical. From below, the child captures areoles more than above. The effectiveness of sucking is determined not through the creation of negative pressure, but through a rhythmic massage of the areola, carried out by the movements of the child's tongue. The baby sucks the bottle of any shape and with any size of the hole the same way an adult sucks from a straw: by creating negative pressure. The tongue is not involved in sucking from the bottle. Milking movements of the language there. The tongue is usually located behind the lower jaw. Therefore, when a child gets used to sucking the bottle in the mouth gets into the breast, he does not know what to do with it. In the extreme version of the wrong nipple attachment falls between the jaws, the baby sucks the breast as well as a bottle. If the nipple is between the jaws, the mother usually experiences quite strong discomfort. The severity of pain depends on the thickness of the skin of the areola and the individual sensitivity of the woman. But in any case, quite quickly the nipple is injured and often already on the second day after childbirth, if you attach it incorrectly, abrasions appear that go into cracks if the attachment is not corrected. This situation is so common that many women consider the formation of cracks to be an inevitable evil accompanying breastfeeding. A very "insidious" is a painless version of the wrong attachment. In this case, the actual nipple falls behind the jaws and lies on the tongue along with a small part of the areola. The child also declines him ... In this case, the mother does not hurt, because nipple baby does not bite. Baby even gets some amount of milk. But the breast does not receive sufficient stimulation and is not well emptied. This gradually leads to a decrease in the amount of milk.
Usually the child in this case is not very good weight gain. Or there is a gradual decrease in gain. For example, in the first month the child added 900g, in the second - 600, in the third - 450. If at the same time the child is somatically healthy, feeds on demand, does not suck anything except the breast, then most likely there is a painless version of the wrong attachment. If a woman has never seen how a baby should suck, if no one showed her how to properly feed a baby and how it should suck, how to control the quality of attachment during sucking, there is a very high probability that she herself will attach the baby not quite right and not will be able to teach him the correct behavior in the chest. She doesn’t know that something needs to be learned here ... In those distant times when breastfeeding in our society was common, and not a rare exception, every woman could help a mother starting to feed, correct her mistakes, show the necessary techniques. Currently, most women do not have the opportunity to study motherhood in practice. Many read a variety of magazines and books for parents and then try to care for their baby and feed him, based on their theoretical knowledge. Unfortunately, the correct attachment of the child to the chest is impossible to learn from books, magazines and pictures. Practical training is required. In maternity hospitals, where most modern babies in industrialized countries are born, no one is engaged in such training. The vast majority of health workers do not have the necessary knowledge. What is necessary for successful training of another woman is first and foremost a personal positive experience of breastfeeding. Nurses and midwives, like most modern women, have no such experience. Wrong attachment, being widespread, does not cause any concern on the part of the medical staff. Women are given only routine recommendations for healing abrasions or cracks, if any. If the baby and the mother have a painless improper attachment and the associated lack of milk, then the problem is solved by the appointment of an additional feed and ends with a rapid transition to artificial feeding, because The supplement is given from the bottle with the nipple, and the rejection of the breast joins the problem of improper attachment. What to do to the woman, putting the kid to a breast?
Try to still find someone who knows how to breastfeed. If it is not possible to find a breastfeeding consultant (in Europe, North America, Australia is not a problem), let it be the mother who feeds not the first child, monitors the quality of the attachment, feeds for a long time, does not use the nipple and pacifiers, never had no problems with nipples (abrasions, cracks). Observe how she feeds her baby and how her baby sucks. This could be your roommate. If you experience unpleasant or sore feelings while sucking a baby, and the medical staff cannot correct anything with their manipulations, try to find a mother who is not inconvenienced while nursing and check with her. Unfortunately, this does not always help, because The size of the nipples, the shape of the breast, the size of the baby’s mouth are very different. The best option for a mother is when a woman with a lot of practical experience and able to distinguish between different types of attachment with different nipple forms teaches her how to apply. For example, at first glance at two nursing neighbors in the ward, especially from a certain distance, it may seem that one mother is doing well, and the other is not very deep. But on closer examination, it turns out that the first mom's grip turned out to be insufficient, although it didn’t hurt the mom, the child actually licks the nipple and the mouth is not wide open enough. The baby will have to retrain and mom to monitor the quality of the attachment. In another case, it turns out that although the baby has a very small mouth, and the mother has a big nipple, the baby stuck out the tongue very well, correctly positioned it, and excellently decanting the breast. When applying a child, try to follow the general recommendations: Put the breast on the child ONLY IN A WIDE OPEN MOUTH! Do not try to push the nipple into the half-open mouth, most likely the child will clamp his jaws or take him not deep enough. Try to act quickly, because wide open child holds his mouth a second or two. If you do not have time, wait for the next time. Help your baby open his mouth by swiping his nipple on the lower sponge several times in a row. Be patient. Very often I observe such mom's actions: the mother takes the baby, tries to attach it, the child shows active searching behavior, turns her head. Mom says: “He does not want!” That is, mom perceives the child's instinctive behavior aimed at finding a nipple as a negative answer from an adult! Or, for example, very often it happens when a mother touches the lower sponge of a child with a nipple, he squeezes her mouth. Mom again immediately says that the baby does not want to suck. And meanwhile, if she continued the offer, then the baby would definitely open his mouth. After all, the child still does not understand what they want from him. He does not know what is expected of him to open his mouth. For most children, it takes at least two weeks to form a steady skill of correct nipple grip, in response to mom's suggestion! Very often, having grasped the breast correctly, the baby slips on the tip of the nipple during sucking and starts to bite. Mom has sore feelings, but she tolerates them. Painful sucking is unacceptable! The baby does not know that he sucks wrong! He needs to be taught to suck properly. If the baby begins to crawl onto the tip of the nipple, the breast must be picked up correctly (by opening the baby's jaw, quickly thrusting the tip of the finger into the corner of the mouth) and re-feed. Usually, the baby slips onto the tip of the nipple if it does not touch the nose of the breast during sucking. In most maternity hospitals, it is recommended to hold the breast above the nose with a finger in order to breathe easier. But the child feels chest face! He should touch the breast with the nose during sucking. This position should be maintained during the entire sucking and at any age of the baby. If the newborn doesn’t touch the nose of the breast, then he doesn’t feel that he is already on the “spot” and can make search movements with a nipple in his mouth! His mother immediately says that the baby does not want to suck. The baby’s nose is arranged in such a way that with a tip it makes a “hole” in the chest and breathes through small triangular or oblong slits at the wings of the nose. Therefore, there is no need to hold the chest with a finger over the nose. Besides the fact that this maneuver spoils the attachment, it also contributes to the occurrence of lactostasis in the upper lobes of the gland, since Mom presses the ducts with her finger and makes it difficult for milk to flow. The baby should not be allowed to pull off the nipple or pass it between jaws to and fro. It is necessary to hold the head when trying to pull off the nipple. And take the breast if the baby starts to “play around”, causing the mother pain. An older child should not be allowed to turn his head with a nipple in his mouth if he wants to look at an object. The kid should follow the subject of interest only with his eyes. Or should let go of the chest and turn his head, if it is so necessary for him. Отдельно хочу отметить «неудобные» формы соска — плоские соски, втянутые, длинные, толстые. Любой новорожденный, способный сосать, может приспособиться к любой форме соска своей матери. Мама, имеющая сосок «нетрадиционной» формы должна проявить больше терпения и настойчивости в обучении ребенка правильно сосать. И она должна постараться, чтобы ее малыш никогда не получал в рот других «оральных объектов», т.к. они в любом случае покажутся ему более удобными для сосания, чем материнская грудь. Для мамы с плоскими и втянутыми сосками очень важен момент втягивания ребенком груди в рот. Если малышу в рот попадает бутылка пустышка или соска, он перестает делать втягивающее движение. Соска и пустышка и так вытянуты, их не надо втягивать дополнительно. Поэтому, когда малышу в рот попадает мамин плоский сосок, он просто открывает рот и ждет, не пытается его втянуть. Маме с плоскими или втянутыми сосками надо постараться не допустить попадания в рот ребенку других объектов для сосания. При необходимости давать докорм или свое сцеженное молоко можно из ложечки, шприца или пипетки. Если у мамы длинные и (или) большие соски, ей очень важно вкладывать их в рот как можно глубже, пронося собственно сосок мимо челюстей. В случае с длинным соском ребенок очень часто смыкает челюсти на соске или сразу за соском. Ареола в рот практически не попадает, малыш ее не сцеживает, получается, что он просто лижет сосок. Молоко он сцедить так не может, грудь не опорожняется и не стимулируется. Начинается нехватка молока. Большой сосок невозможно вложить в недостаточно открытый ротик. Малыш, пососав соску или пустышку, перестает широко открывать рот, т.к. для сосания этих предметов совершенно не нужно открывать рот широко. Ребенок с самым маленьким ротиком может сосать грудь своей мамы с самым большим или длинным, или любым другим «неудобным», с нашей точки зрения, соском. Надо только правильно вложить грудь в рот, проявить терпение и настойчивость. Всего-навсего. Обучая ребенка правильно сосать, мама обеспечивает ему в будущем полноценное, идеально подходящее питание, а себе — продолжительную стабильную лактацию. Педиатр и консультант по грудному вскармливанию, Лилия Казакова.
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Proper attachment of the baby to the chest. What it is?

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