I learned from Wolf and Glass (both in their presentations and from their
book) the technique of paced bottle feeding.  If this little one has to have
alternative feeding due to fatigue or weak feeding at breast, the feeders
should carefully observe for the fact that swallowing (handling fluids) can
overwhelm respiration.  Some babies with compromises like this need to have
the bolusing carefully spaced to allow the baby time to re-organize
breathing. Otherwise, feeding becomes stressful, marked with baby holding
breath and trying to chug enough food to satisfy hunger before running out
of air.  These feedings are marked by lots of gasping, air swallowing,
choking, milk spilling out of corners of mouth, stress cues, etc. Or baby
will eat a small amount and then "check out" by falling asleep.

 Give the baby only one-two swallows, then pause to allow a few catch-up
breaths. Then repeat one-two swallows. Never force the baby to keep feeding
at breast or alternatively if baby tries to pull back.  Baby is
communicating he needs to re-organize respiration.    If bottle feeding,
pull the nipple out and rest it on the upper lip (so baby doesn't think you
are just taking it away for good) or you can tip the bottle down, leaving
the teat in the baby's mouth, but dropping the fluid out of the teat.  Or
you could use a haberman feeder and turn the bottle so you stop the flow of
the liquid. If cup feeding, follow baby's cues and observe for baby drawing
back, color changes around the lips.  If finger feeding, allow baby to
initiate bolusing by sucking actively.

 I would certainly support  the use of exclusive human milk feeds so that if
fatigue aspiration occurs the baby's tissues will be bathed with milk not
formula.  Gentle use of infant strength saline nose spray can help clear
milk debris from the nasal pharynx if baby sounds stuffy.  Nose needs to be
clear during feeding so baby can breathe when mouth is full of breast or
bottle or finger (or whatever).

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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