TABLE 4.

Breastfeeding problems: popular sociocultural and clinical advice which disrupts parent-infant biobehavioral synchrony compared with Neuroprotective Developmental Care strategies which promote parent–infant biobehavioral synchrony.

Breastfeeding: infant cue	Most likely cause	Popular diagnoses or advice	Neuroprotective Developmental Care strategy
Difficulty coming onto the breast	Positional instability, breast tissue drag, landing pad encroachment	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy	Optimize fit and hold to optimize positional stability (gestalt breastfeeding)
Back-arching and pulling off at the breast	Positional instability, breast tissue drag, landing pad encroachment	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy	Optimize fit and hold to optimize positional stability (gestalt breastfeeding)
Dialing up at the breast	Positional instability, breast tissue drag, landing pad encroachment	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy	Optimize fit and hold to optimize positional stability (gestalt breastfeeding)
Dialing up whenever approaches breast or during breastfeeding (‘oral aversion’)	Conditioned hyperarousal (dialing up) of SNS, often secondary to positional instability but persisting once fit and hold are corrected	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy	Comprehensive intervention for conditioned hyperarousal of SNS
Marathon feeds or excessively frequent feeds	Poor milk transfer	Oral ties, oesophagitis, reflux, wind pain or gas, colic, allergy	Optimize fit and hold to optimize milk transfer (gestalt breastfeeding)
Falls asleep at the end of a breastfeed	Normal biological process (↑ parasympathetic nervous system response, ↑ oxytocin, ↑ cholecystokin)	Allows bad habits or sleep associations to develop	Parents educated about healthy function of the biological sleep regulators