Body-Led Breastfeeding: Understanding Infant Suck Strength with Dr. Ellen Chetwynd

In this episode of Behind the Latch, Margaret sits down with Ellen Chetwynd, IBCLC, PhD, and longtime Editor-in-Chief of the Journal of Human Lactation, to explore a fundamentally different way of understanding breastfeeding challenges: body-led breastfeeding and the Infant Suck Strength Exam (ISSE).

Dr. Chetwynd shares how years of clinical practice—and noticing what wasn’t explained by common diagnoses like thrush, Raynaud’s, or tongue-tie—led her to focus more closely on the infant’s body, neurology, and suck function. Together, Margaret and Ellen unpack how the ISSE helps clinicians move beyond appearance-based latch assessment to identify where suck strength is weak, how the tongue is functioning at the breast, and how infant compensation patterns often drive pain, inefficiency, and feeding struggles.

This conversation bridges lactation science, cranial nerve physiology, and gentle body-based intervention, offering clinicians practical tools while challenging reductionist approaches to infant oral dysfunction.

🔍 What We Talk About

1. How Ellen entered the field of lactation through nursing and public health
2. Why “bucket diagnoses” (yeast, Raynaud’s, tongue-tie) persist in lactation care
3. What body-led breastfeeding means—and why the baby is often the primary driver
4. The clinical gap that inspired development of the Infant Suck Strength Exam (ISSE)
5. Why digital oral exams miss what’s happening at the breast
6. How the ISSE is performed and what each pull-back reveals about suck strength
7. Why the ISSE often functions as both assessment and treatment
8. Infant compensation patterns: jaw movement, lip use, body tension, and asymmetry
9. The role of cranial nerves and the cranial base in feeding function
10. Why asymmetric latch and “guppy pose” can sometimes worsen dysfunction
11. Gentle, parent-taught techniques to support infant regulation and suck strength
12. How bottle-feeding strategies must align with breastfeeding goals
13. When to consider referral for craniosacral or body-based therapy
14. Why frenotomy alone may destabilize function if body tension isn’t addressed
15. What future research is needed to validate and study the ISSE

🧠 Key Takeaways for Clinicians

1. A visually “good” latch can hide significant internal dysfunction.
2. Infant suck strength and tongue function must be assessed during active feeding.
3. Many breastfeeding problems originate in infant neuromuscular coordination—not maternal anatomy.
4. Babies often compensate with their bodies when oral function is inefficient.
5. Gentle pull-back techniques can cue strength and improve function without causing pain.
6. Positioning that supports a neutral cranial base is critical for effective feeding.
7. Body-based approaches may reduce unnecessary procedures and improve long-term outcomes.
8. The ISSE offers clinicians a structured, repeatable way to assess progress over time.

👩‍🏫 Guest

Ellen Chetwynd, PhD, IBCLC

www.bodyledbreastfeeding.com

Upcoming Workshop: https://www.bodyledbreastfeeding.com/lactation-support-workshops

Self-Paced Courses: https://teachingbabiestonurse.thinkific.com/collections

Body-Led Breastfeeding Podcast:

Spotify: https://open.spotify.com/show/7sxiNwaRMppZ8AfjF98C6K

Apple: https://podcasts.apple.com/gb/podcast/body-led-breastfeeding/id1789167683

Former Editor-in-Chief, Journal of Human Lactation

Co-founder, Body-Led Breastfeeding

Chapel Hill & Durham, North Carolina

📝 Connect with Margaret

📬 Email: hello@margaretsalty.com

📸 Instagram: @margaretsalty

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🎙 Podcast: Behind the Latch

Hosted by: Margaret Salty

Music by: The Magnifiers – My Time Traveling Machine

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