Hi Reader
Dad Joke: What do you call a baker holding a bag of sugar in each hand? Ambidextrose.
A baby was referred to me recently for an issue with his “suck reflex”. Now, as soon as I see that, it’ s very easy to mentally zoom straight into the mouth. Tongue. Palate. Jaw. Latch. Seal. Vacuum. Tie. Release. Reattachment. Exercises. All the usual suspects. But this one…well this one was slightly different…
I started by stimulating the rooting reflex and instead of orientating beautifully and opening into a feeding pattern, he clamped. A proper little “nope” from his system.
That told me straight away the suck mechanics were not flowing well and his pattern was not easy to access. Eventually, I got my finger into his mouth to assess the suck more directly.
And then it stopped…Completely.
It was like an engine that had stalled.
No rhythm.
No draw.
No wave.
Just nothing.
This baby had just had a tongue-tie resection. Structurally, things looked on point. The tissue restriction had been dealt with. The mouth had the potential to do the job.
But potential is not the same as function and sometimes, after the anatomy has been corrected, the nervous system still needs to find the pattern.
The mouth may be free, but the baby still needs to know how to use it.
That made me think back to some myomunchee training I had done, where they spoke about primitive reflexes “sharing sugar”. I love that phrase.
The idea is that some of these primitive reflex pathways are neighbours. Their nuclei sitting close together in the brainstem. They are not isolated switches living separately. They are part of a wider neurological neighbourhood. And so if one reflex pathway is struggling to come online, sometimes stimulating another related pathway can help wake the system up.
A bit like popping next door to borrow a cup of sugar, or, in this case, borrowing a little neurological activation.
So I got mum and dad involved.
Mum stimulated the palms. Dad stimulated the soles. Palmar and plantar input, while I worked on helping the suck mechanics reset.
And then it happened. The stalled engine turned over, then caught and started running. The pattern began to come back online.
The mouth is not separate from the brainstem and the suck is not separate from regulation. Feeding is not just anatomy and reflexes do not live in neat little boxes. They are all part of a wider system.
A week later, I followed up and baby was sucking beautifully.
That does not mean palmar and plantar stimulation is the answer to every breastfeeding problem. It is not a recipe. It’s not “do this three times and the baby feeds”.
It’s about asking:
“Can the baby find the pattern?”
“Can the nervous system access the sequence?”
“Is the suck organised, or is it stalling?”
“Are there other primitive reflex pathways that might help the system wake up?”
“Is the baby clamping because the mouth is restricted, or because the mechanics are confused?”
If we only look at the mouth, we may miss the system.
These are the kinds of clinical conversations we keep having inside Connected Paediatrics. Not protocols for the sake of protocols. Not “one trick” solutions. But real cases, real clinical reasoning, and the kind of thinking that helps us become better at seeing the whole baby.
Because in paediatrics, the magic is often not in doing something bigger… It’s in noticing the small thing that tells you where the system has lost its way.
Chat Soon
Mike