When a family comes to see me because feeding isn't going the way they expected, they often assume I'm going to watch the latch.
I am watching the latch.
But I'm watching a whole lot more than that.
I'm watching what happens when you pick your baby up. I'm noticing how they turn their head, how they move their arms and legs, whether they seem comfortable being handled, and how easily they settle into your body. I'm watching what happens when they become hungry and what their body does before they ever reach the breast.
I'm noticing whether they root, whether they can open their mouth widely, whether their tongue moves forward, and whether their head and neck are able to move freely enough to find the breast. I'm watching whether they approach the breast symmetrically or consistently favor one side.
And then, yes, I watch the latch.
But even there, I'm looking beyond whether the nipple is technically in the baby's mouth.
I'd want to know: How did the baby get there? What did their body have to do to make it happen?
Did they lead with their chin? Did their head tip back naturally? Did they open widely, or did we have to work to get their mouth open? Did they seem to use their primitive reflexes effectively, or did something interrupt that process?
I Think About Feeding Like I Used to Think About Debugging
Before I worked in lactation and craniosacral therapy, I spent a lot of time working in web development. One of the things I loved about that work was debugging.
When something wasn't working, the problem was rarely as simple as the thing you could see on the screen.
A button wasn't responding. A form wasn't submitting. A page was behaving strangely. The surface symptom gave you a place to start, but it didn't necessarily tell you where the actual problem lived.
So you followed the clues.
You looked at what was happening underneath the surface. You tested one possibility, then another. You changed something and watched what happened. You worked through iterations, sometimes finding that the thing you thought was causing the problem wasn't actually the root cause at all. Eventually, you found the piece that wasn't working as it should, repaired it, and tested again.
I realize now that I approach feeding assessments in much the same way.
A shallow latch is a symptom.
Clicking is a symptom.
Nipple pain is a symptom.
A baby who seems frustrated at the breast is a symptom.
Those things are important. They're telling us something. But they don't necessarily tell us why they're happening.
And that's the part I'm most interested in.
I'm looking for the root of the problem by paying attention to what happens underneath the obvious symptom. Then I can make a change, observe what happens, and keep adjusting until we have a better understanding of what's actually going on.
That doesn't mean I'm treating a baby like a computer, obviously. Babies are considerably more complicated, and they have opinions about debugging.
But the underlying way of thinking is remarkably similar.
I'm Watching the Whole System
When I watch a baby feed, I'm not just watching their mouth.
I'm watching their breathing, their swallowing, their facial expression, and their overall effort. I'm listening for clicking. I'm watching whether they stay deeply latched or repeatedly slip toward the end of the nipple. I'm noticing whether they seem relaxed while feeding or whether their entire body looks like it's working very hard.
I'm also watching what happens before the latch.
How does the baby respond when you pick them up? How do they organize their body? Can they comfortably turn their head in both directions? Do they settle into your body, or do they seem to brace, arch, or resist? What happens when they become hungry?
Sometimes those details tell me much more than the latch itself.
And I'm watching you, too.
How are you sitting? Are your shoulders creeping toward your ears? Are you holding your breath? Are you trying to keep your breast perfectly still while simultaneously supporting a newborn who appears determined to launch themselves into another dimension?
Because feeding isn't something the baby does to the parent.
It's something the two of you are doing together.
That means your body matters, too.
I want to know whether feeding hurts, but I also want to know where it hurts, when the pain starts, whether it improves during the feeding, and what your body does in response. Sometimes a parent has become so accustomed to discomfort that they don't even realize how much tension they're carrying.
I'm Looking for Patterns
One of the most useful things in any assessment is a pattern.
Maybe the baby consistently turns their head to one side. Maybe they become frustrated when asked to feed in a particular position. Maybe they have a difficult time settling after being moved. Maybe they seem to have plenty of strength but very little organization. Maybe they can latch beautifully on one side and struggle on the other.
Those details matter.
They don't necessarily tell me what is wrong. They give me questions to ask.
I don't look at a baby and think, “This tells me exactly what's happening.”
I think, “I wonder why.”
Why does this position seem easier?
Why does this side feel different?
Why does the baby organize beautifully for the first few minutes and then fall apart?
Why does the mouth open easily in one situation but not another?
Why does feeding seem to require so much effort?
Those questions are often where the assessment really begins.
The Feeding Is One Piece of the Story
This is where the pregnancy and birth story becomes important, too.
If a baby is struggling to feed, I want to know what happened before feeding ever became an issue.
How was the pregnancy? How did your baby move? Were there any concerns about positioning? What was the birth like? Was labor long or particularly intense? Was there a cesarean birth? Vacuum or forceps? A difficult induction? A lot of time spent in one position?
None of those things automatically mean there will be a feeding problem.
Birth isn't a diagnostic checklist.
But birth gives me context.
The same is true of the baby's life since birth. How much time are they spending in different positions? Do they tolerate tummy time? Do they turn both directions? How do they sleep? How do they respond to being carried? What happens when they're upset?
All of those pieces help me understand the baby I'm sitting with rather than simply the latch I'm looking at.
And sometimes the answer really is a small adjustment in positioning.
Sometimes the baby simply needs a little more support to use the reflexes they already have.
And sometimes the feeding difficulty is a clue that there is something else worth exploring.
Testing, Adjusting, and Looking Again
This is another place where my old debugging brain comes in handy.
I don't expect to figure everything out from one observation.
Sometimes we'll make a small change in positioning and see what happens. Maybe the baby's mouth opens more easily. Maybe the clicking disappears. Maybe the parent suddenly realizes that the feeding doesn't hurt anymore.
That's information.
Sometimes the change doesn't help at all.
That's information, too.
We can try something else, observe again, and gradually build a clearer picture of what the baby and parent need.
This is one reason I don't love rigid formulas for feeding.
Babies aren't standardized systems, and neither are parents. What works beautifully for one dyad may make no sense for another. The goal isn't to force every feeding relationship into the same configuration. It's to understand what this particular baby and this particular parent are doing, identify where things seem to be getting stuck, and figure out what might help.
My job isn't to decide that every feeding problem needs bodywork.
My job is to notice what I'm seeing, ask good questions, and help you figure out what kind of support makes sense from there.
That might mean working on latch and positioning. It might mean CST. It might mean an evaluation with another provider. It might mean a combination of approaches.
The goal isn't to make the feeding look perfect.
The goal is to understand why it feels hard and figure out what might make it easier.
Sometimes that means fixing the thing we can see.
Sometimes it means looking a little deeper.
And sometimes the most important part of an assessment is simply realizing that the symptom we came in with wasn't the whole story.
