From No Suck to Small Steps: A Story of Persistence and Care
Submitted by Meredith Harewood MSN RN IBCLC
Tags: breastfeeding infants
The newborn was not sucking at all – not on the breast, not even on my finger after significant oral stimulation. What should be a primitive oral reflex - an involuntary motor response originating in the brainstem after birth that facilitates survival- was simply not happening for this full-term infant at 20 hours of life. As a Registered Nurse Certified Lactation Consultant working at a large Women & Babies’ Hospital, which delivers ‘a kindergarten class every day’, I see a multitude of mom/baby couplets. While not unheard of, it is rare to have a newborn who does not suck. Oral primitive reflexes are necessary for newborn feeding. The suck reflex, if not immediately present, can most often be stimulated with gentle massage to the cheeks, tongue, and soft palate, and then transferred to the breast to facilitate breastfeeding. Some newborns just seem to need ‘reminding’ or need a little extra time to coordinate their brains and bodies. It is a joy to be a small part of this ‘awakening’ and to see the baby and mom both learning to breastfeed, a brand-new skill for both parties in the case of a first-time mom, and one that requires significant practice. In the case of baby ‘G’, it was perplexing indeed to feel nothing but air with no compression down on my fingers at all, no lift or forward motion of the tongue, no reflex OTHER than that of ‘communicating’; that is, of crying…….which baby G was doing with style. At this point, it was crucial to support Mom with settling techniques and to ensure she felt comfortable with removing her breastmilk via methods other than breastfeeding, so that she could feed by either finger-feeding or syringe-feeding.
At least baby G was going to receive the all-important first breastmilk via drops, while I brought in some other interdisciplinary support to further explore the missing reflex. Most medical professionals will understand the call to detective work as part of our practice. Just like the famous Sherlock Holmes, we collect clues. These clues include objective findings, as well as clues involving the holistic approach to healthcare, such as mood, affect, situation, support, underlying conditions, history of pregnancy, method and details of delivery, among others. As I worked with mom, using an official Spanish language interpreter, I was able to determine that mom was 100% committed to exclusive breastfeeding and was fastidiously pumping every 2 hours since baby G’s birth just 20 hours prior. She was ‘doing all the things’ as we say in the lactation speech. My heart went out to her, a first-time mom who just wanted to have her baby at her breast, doing the all-important skin-to-skin contact and letting her beautiful newborn suckle. I was determined to support her goals of breastfeeding and to support her and her partner, who was supportively involved, in the transition to parenthood. Calling in the assistance of our inpatient Occupational Therapy department, I arranged to have an OT consult for baby G.
This consult revealed a mildly recessed jaw and jaw quivering along with the inability to breastfeed; however, the ability to bottle feed with a bottle, albeit taking an extraordinary length of time for baby G to physically remove the formula from the bottle. Because the baby could take a bottle, the pediatrician deemed it a safe discharge. With the parents amenable to bottle feeding as a backup to continued breastfeeding attempts, baby G was discharged home. We care for our patients, but we also care ABOUT our patients. At times, it can be a frustrating aspect of our nursing experience, not knowing the whole story about a patient we have cared for in the hospital. In my role, I have the fortunate ability to have follow-up communication with my patients under certain circumstances, and in the case of baby G, I was able to continue communication with the family post-discharge. I do not have dual language ability in Spanish, so I used our official telephonic interpretation service to leave a message for the family, as well as using Google Translate to write an email. I sent the email with a ‘wing & a prayer’ because, honestly, who really knows how legitimate a translation via this online service is?? So it made my day to receive a return email from mom reading: Hello Meredith, how are you? Thank you for your interest. My milk production has increased considerably, which luckily prevents us from giving him formula, but I still have a hard time breastfeeding him. I get desperate too and give him a bottle. It was absolutely thrilling to hear that mom’s milk is increasing in volume and that she is able to produce sufficient milk to feed baby G exclusively with breastmilk, as this supports the parental goal of breastmilk feeding. Regarding the continued struggle with breastfeeding, I recommended that mom come in for a one-on-one lactation consultation with our outpatient lactation consultant at the hospital. During the consult, the outpatient consultant noted that at day 8 of life, baby G was able to remove only 0.1 oz at the breast with 40 minutes of sucking.
Most 8-day infants would be able to remove somewhere from 1-3 oz. Baby G was seen to have oral tension, limited tongue extension & elevation and it was recommended to see our outpatient Occupational Therapy team secondary to the ineffective sucking at the breast. Early osteopathic treatment may be effective for improving the resilience of sucking modalities in otherwise healthy newborns. When you are pregnant, especially perhaps with your first, it is natural to have plans in place for what you want your pregnancy to look like, how you picture your birth, and how you plan to parent your child. When these plans get interrupted or completely abandoned due to medical concerns or other considerations, it can be truly devastating, and as a mom myself who had many detours with my own birth stories, including urgent surgical births, NICU stays, low milk supply, postpartum depression, and other challenges, I empathize completely. So I felt mom’s pain, having given her all to breastmilk production and attempts to breastfeed; having made it into the hospital for an outpatient consult at day 8, and now being told that yet another outpatient specialist was recommended, no immediate resolution to the problem, and, deep down, the defeating thought ‘what is wrong with my baby?’. It was no surprise that mom burst into tears as the outpatient lactation consultant changed little baby G’s diaper. As I was able to be present for the consult, I consoled mom and involved dad in the caring circle for this mom who, despite all her efforts, had a baby who was not effectively feeding at her breast. Baby G’s story continues, with twice monthly outpatient OT visits, continued commitment to pumping and bottle feeding from mom, and continued efforts at the breast. Breastfeeding has been described by many of my own patients as ‘harder than the birth itself,’ and they are not referring necessarily to pain but more to the struggle of learning to breastfeed. It is common for moms to share their feelings of being overwhelmed when experiencing breastfeeding difficulties.
I am so thankful and blessed to be able to support families through this time, but it is not easy to see the struggle and know that sometimes, it actually doesn’t work out. In this case, mom was so dedicated to breastfeeding and dad was right there beside her every step of the way; and the family had support right from the start of baby G’s life from the services our hospital can offer. One thing we’ve learned from this is that our inpatient OT team should offer human donor milk for any breastmilk-feeding baby for the inpatient bottle-feeding trials. We’ve subsequently changed our procedures for this, to improve our quality of care. All healthcare providers, from the bedside to the boardroom, have a crucial role in ensuring effective change. Hello Meredith, nice to meet you after a few weeks. I wanted to tell you about G's progress regarding occupational therapy. We have been making progress and strengthening his muscles and with it he now breastfeeds more regularly/O Dear O, I am SO happy to hear about G’s progress with OT! That is wonderful news. Please stay in touch as I am thrilled to hear about your progress! Meredith Sometimes, we need a little extra help, whether that be from skilled multi-disciplinary providers, our partner and support ‘village’, or even ‘Mr Google Translate’, but the idea is to keep taking one step after the other. I can only wish G, the family, and all other mommas out there the best, and let them know that all their efforts are part of becoming the amazing parent they were meant to be.
References
- Barrow, J. M., & Annamaraju, P. (2022, September 18). Change Management in Health Care. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459380/
- Modrell, A. K., & Tadi, P. (2023, March 6). Primitive Reflexes. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554606/
- Parodi, A., Ruffa, R., Viola De Felice, Sartini, M., Maria Luisa Cristina, Martino, B., Bianco, F., Roberta Di Stefano, & Mazzella, M. (2024). The Efficacy of Early Osteopathic Therapy in Restoring Proper Sucking in Breastfed Infants: Preliminary Findings from a Pilot Study. Healthcare, 12(10), 961–961. https://doi.org/10.3390/healthcare12100961
- Rowles, G., Keenan, J., Wright, N. J., Hughes, K., Pearson, R., Fawcett, H., & Braithwaite, E. C. (2025). Investigating the impact of breastfeeding difficulties on maternal mental health. Scientific Reports, 15(1). https://doi.org/10.1038/s41598-025-98357-6