Clampdown Bite Reflex
by Mary Jozwiak
from LEAVEN, Vol. 30 No. 4, July-August 1994, pp. 53-4
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time
When a mother calls to say her nipples are sore, a Leader immediately explores the possibility of improper positioning or thrush. But if the mother describes her newborn as biting down on her nipple, the Leader may also want to consider "clampdown bite reflex." This term aptly describes a frequently overlooked breastfeeding problem that can often be resolved with specific management techniques. Clampdown bite should not be confused with clinical tonic bite, a rare neurological problem requiring the help of a physical therapist or neurologist.
Sore nipple strategies usually bring little relief. Although treatment of nipples may be soothing if they are cracked or bleeding, the underlying problem can only be resolved by working with the baby.
Recognizing Clampdown Bite
When it does occur, clampdown bite is almost always present from birth. A reflex causes the baby to clamp down with his jaws when swallowing or when anything is placed in his mouth. This causes severe pain because the bite is strong enough to cut off the blood supply to the nipple. The nipple may have a white stripe on it. This should not be confused with the flaky white patches of thrush. With clampdown bite the nipple color returns after a short time although the pain may persist. In severe cases some nipples may even be bruised.
Clampdown bite is more prevalent after a difficult or medicated birth or when there is a neurological problem. Meconium staining is often seen during the birth. A baby may be hypertonic, with excessive muscle tone, arching, and be difficult to cuddle. It is often helpful to observe the baby or ask the mother how the baby holds his body if clampdown bite is suspected.
The baby may also be very hungry or not gaining weight. Nipple pain may prevent proper milk ejection; biting may prevent adequate sucking and swallowing.
Treating Clampdown Bite
In many cases as baby's brain matures, he becomes neurologically better organized and outgrows the biting in a few weeks. In the meantime, there are ways the mother can help baby nurse more comfortably and efficiently. Learning to coordinate sucking and swallowing as baby learns to breastfeed may help his overall neurologic development.
If the baby is hypertonic or has excessive muscle tone, a gentle massage working from the extremities in toward the center of the body can be calming. Some babies may be calmed by a warm bath with mother. Using the football hold with baby's feet going up the back of mother's chair or swaddling in a slightly flexed, tucked position will counteract the arching. The mother may need to use a folded diaper behind baby's head to reduce the stimulation to a sensitive baby. The room should be as quiet and as distraction-free as possible.
Wiping the baby's face with alternating warm and cool water before nursing helps relax the facial muscles. Gently using a finger to exert downward pressure on baby's chin while nursing can counteract the clenching of his jaws. If the mother's finger tends to slide off, she can wrap the finger with a small piece of gauze.
If the baby is losing weight, the mother may need to express her milk and feed it with a medicine syringe, dropper, or small cup. Baby should be in a semi-upright position and the cup should be tipped so the milk touches baby's upper lip. The baby will begin to sip and swallow at his own pace. Do not pour milk into the baby's mouth. Such alternate feeding methods help avoid nipple confusion. They also help the baby overcome clampdown bite since use of a rubber nipple increases the chances that the problem will continue.
A baby may also need to be fed with expressed milk if the clampdown bite is severe or unrelenting. Be sure that the mother pumps frequently in order to keep up her supply.
Babies with clampdown bite almost always outgrow their problems. However, since some of the symptoms suggest birth trauma or neurological problems, the mother should be encouraged to have the baby checked by a health care provider.
Listen to the mother when she insists that something is "wrong" with the baby. Encourage her to find a doctor who will take her feelings seriously. A mother may want to get a second or third opinion and may even need to change doctors.
With help and time most babies with clampdown bite can learn to nurse well. Some mothers may be urged by family or friends to give up breastfeeding. LLL can offer the information and support they need to continue breastfeeding as long as they wish. Babies with neurological problems will benefit greatly from breastfeeding.
Questions to ask mother:
- How does the nipple look after a feeding? If it turns white, it may indicate that baby is clamping down.
- How does it feel when baby nurses? Does it feel as though baby is biting or clamping down during most of the feeding? Many babies clamp down only when they fall asleep. This is not clampdown bite reflex.
- When do you feel pain? Is the pain present throughout the entire feeding, perhaps even increasing after the baby comes off the breast? Sometimes the blood flowing back to the nipple is the most painful.
- How is baby positioned and latched on? Has positioning ben checked by a Leader?
- How is the baby's overall health? How was your birth experience? This gives the mother a chance to mention neurological problems without the Leader unduly upsetting the mother.
Brewster, Dorothy P. You Can Breastfeed Your Baby Even in Special Situations. Rodale Press, 1979.
Crase, Betty, personal consultation.
Mohrbacher, Nancy and Julie Stock. THE BREASTFEEDING ANSWER BOOK. Franklin Park, Illinois: La Leche League International, 1991.
Meintz-Maher, Susan. An Overview of Solutions to Breastfeeding and Sucking Problems. Franklin Park, Illinois: La Leche League International, 1988.
UCLA Extension, Dept. of Continuing Education in Health Sciences, Division of Nursing. "The development of normal infant suckling skills: implications for assessment and intervention." June 9-10, 1989, Schaumburg, IL.
UCLA Extension, Dept. of Continuing Education in Health Sciences, Division of Nursing. "Experiential breastfeeding: implications for assessment of and intervention in clinical breastfeeding management." October 5-6, 1990, Chicago, IL.