Even more importantly, little Zachary came off the vent on Christmas day
after almost 2 full mos! He's now on a high-flow nasal cannula. He is
tolerating full feeds by gavage and gaining well. He's not quite ready to
po feed due to his oxygen requirement, but she is looking forward to
hopefully teaching him to breastfeed. Hopefully her great supply will make
it easier for baby to get fed at breast.
There is some concern that the baby has a groove in his palate from being
intubated so long. Is that likely to cause a problem? And any tips on
teaching a baby that has been so ill to breastfeed?
Jennifer Tieman
Family Physician
Mom to 4, including my toddler nursling Caroline Rose
I certainly concur with as much skin to skin as possible and starting
Zachary breastfeeding on an almost empty breast with a 16 mm nipple shield. Nasal
cannula oxygen should not, in and of itself, keep him from breastfeeding
unless he is in such respiratory distress that he is very unstable. Non nutritive
sucking should not distress him. One thing about breastfeeding, unlike bottle
feeding, is that you cannot force a baby to do it. If he is not ready he
just plain won't suck. Mom can be taught to watch his cues and the O2 sat
monitor to make sure he is not being overstressed. I usually start tiny babies with
one session per day with no real emphasis on nutrition. The grooved palate,
secondary to the endotracheal tube, can be a problem. These very tiny babies
who have been intubated have narrow palates and marked grooves and although
they latch, are sometimes unable to milk the breast adequately.. The huge
supply your friend has, Jennifer, can do much to overcome this, becaues along
with this oversupply will be fast easy flow--sort of like using a red premie
nipple on the baby. At first mom may be very frightened of breastfeeding a
small, fragile baby so it is helpful if you could sit with her through the entire
feeding seesion, helping with latch and position and reassuring her that you
will keep the baby safe. Also, these small premies frequently hold the
nipple in their mouths for 5-10 minutes before they ever start sucking. I find
when they are totally comfortable and have regulated their breathing,
temperature, etc. to mom they begin to suck. Positioning is very important because a
premie cannot readjust--make sure the chin is well tucked and body is wrapped
around mom in cross cradle with baby's bottom in her elbow. The nipple shield
will stabilize the nipple in the baby's mouth--wetting the edges to "glue" it
in place for mom is helpful. Good luck!
Kathy Boggs, RN, IBCLC
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