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PBL Foundations


  • COMMON BREASTFEEDING PROBLEM #1: nipple and breast tissue drag
  • How do you know if your breastfed baby has fit and hold problems?
  • Babies dial up when they have an unstable position at the breast
  • Fit and hold problems are commonly misdiagnosed in breastfeeding women and their babies
  • The three key elements of stable fit and hold for enjoyable breastfeeding
  • The mechanical effects of nipple + breast tissue drag on breastfeeding
  • Popular approaches which disrupts fit and hold

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  • PBL Foundations
  • S3: Fit and hold: #1 breastfeeding superpower
  • CH 2: Why does fit and hold matter so much?

Babies dial up when they have an unstable position at the breast

Dr Pamela Douglas1st of Sep 20236th of Jan 2026

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If baby is restless, or fussing and fretting, or starting to cry at the breast, we call this 'dialling up' at the breast, that is, a dialling up of the baby's sympathetic nervous system (SNS). When your baby dials up, you are likely to find yourself dialling up too! You can find out more about this here.

  • This dialling up of your own SNS in response to your baby's dialling up is normal, and biologically hardwired. You might feel upset and worried and find yourself having a lot of difficult thoughts like “I'll never be able to do this,” or “I'm a failure as a mother.” You can find out about the ways our brain changes after giving birth to a baby, and how to care for ourselves and manage difficult thoughts and feelings, starting here.

  • When the baby dials up, he not only fusses, back arches and cries, he may also vomit or puke more often, due to the effects of the dialling up on the gut. This reflux or vomiting doesn't do her harm, or require treatment.

The gestalt method of fit and hold is a holistic way of helping our babies and ourselves dial down with breastfeeding, that is, have relaxed, enjoyable experiences while effectively feeding our babies from our bodies, without pain.

The little one in the photo on this page is looking worried! He's starting to dial up at the breast and he certainly doesn't seem to be fitting well into his mother's body. He's experiencing positional instability (that is, he is in an unstable position or an unstable fit and hold), and it's also very likely that his mother is experiencing the painful effects of nipple and breast tissue drag. Hopefully once you've worked through the basics of Possums Breastfeeding & Lactation, you'll be able to see what's going on for them, and what might help!

Selected references

Douglas PS, Keogh R. Gestalt breastfeeding: helping mothers and infants optimise positional stability and intra-oral breast tissue volume for effective, pain-free milk transfer. Journal of Human Lactation. 2017;33(3):509–518.

Douglas PS, Geddes DB. Practice-based interpretation of ultrasound studies leads the way to less pharmaceutical and surgical intervention for breastfeeding babies and more effective clinical support. Midwifery. 2018;58:145–155.

Douglas PS, Perrella SL, Geddes DT. A brief gestalt intervention changes ultrasound measures of tongue movement during breastfeeding: case series. BMC Pregnancy and Childbirth. 2022;22(1):94. DOI: 10.1186/s12884-12021-04363-12887.

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Next up in Why does fit and hold matter so much?

Fit and hold problems are commonly misdiagnosed in breastfeeding women and their babies

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Your baby will commonly receive misdiagnoses when there are (undetected) fit and hold problems

We have a serious health system blind spot about fit and hold problems, which are often inappropriately diagnosed as medical conditions or infant suck dysfunctions. Here are the various diagnoses babies might be given when they're actually showing signs of an unstable position and breast tissue drag in breastfeeding.

  • Cranial nerve, neurological or motor dysfunctions (wrongly said to cause impaired tongue movement and poor suck)

  • Allergy

  • Reflux

  • Gut pain or dysbiosis

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Possums acknowledges the traditional owners of the lands upon which The Possums Programs have been created, the Yuggera and Turrbal Peoples. We acknowledge that First Nations have breastfed, slept with, and lovingly raised their children on Australian lands for at least 65,000 years, to become the oldest continuous living culture on Earth. Possums stands with the Uluru Statement from the Heart.