When assessing a child with nursing difficulties, there are several questions we first need to ask the mother before we begin to examine the child- Can the child nurse in the standard front position or can the child only nurse in the "football hold"? This is likely to point out to a problem with the cervical spine, especially a problem with cervical extension misalignment- Can the child nurse equally on both breasts or does the child have more difficulty on one side ? This is likely to indicate a cervical spine rotation misalignment problem- Can the child get a wide enough latch on the breast or this the child clamping down on the nipple alone, "barracuda" style ? This can point to several issues including a jaw misalignment ( if the baby's head is stuck sometime the attending OBG will have contact on the front of the face to pull them out), inability to extend the cervical spine, or more of a neurological delay with general hypertonicity- Once latched on, can the baby keep the latch or does it suddenly pull back ? This strongly points out to a cervical hyperextension malposition and the inability to hold a flexed position - Is the child suckling straight or does is side swipe ? This points out to a jaw problem or neurological inefficiency.- Is the child averse to any particular position such laying on their back, sitting in the car seat ? This strongly points to cervical hyperextension rigidityThere are some strong clues as to what may have happened to child's head and neck from the labor and birth history:- Was labor Pitocin induced with very strong prolonged contracting before the baby was able to crown? - Did the baby's head get stuck, and if so, did the attending OBG mention if the baby's head was in the rotation phase ?- Was this a normal face up presentation or sunny side up ?- Was vacuum extraction used, or other force to the head ?- Was this a C-section birth ? If so was it scheduled, or emergency, and how was the baby extracted ? C-section births are probably the most unpredictable of all when it comes to mechanical stress to the baby. Especially for non-scheduled C-sections, the baby will already be engaged in the birth canal and sometime an attending OBG has to extract the baby by grabbing any body part they can actually get a hold of in a very small space.
