Cathy writes:

I am not  sure how therapists are being taught about neck position for 
infant feeding,  but for children with cerebral palsy or other neurological 
issues eat solids,  therapists are taught to tuck the chin a tiny bit (stabilize 
it back toward  the neck, in a mostly neutral position). Perhaps that's the 
source of the  confusion? Overapplying a special case?
~~~
Hello Cathy and all,
 
I think we're on to something here. The SLT I've been working with did  
exactly the opposite of what I had demonstrated to the parents: held baby 
tight,  with pressure behind the neck to push it into a light flexion/neutral  
and  she said it was "more stable." I think her underlying message was "during 
 bottlefeeding, for a baby dealing with some other issue" - for instance 
she  thought this baby was low tone. Babies that are having difficulty 
bottlefeeding  for a period of time long enough to consult an SLT would generally 
mean that  this baby is having some kind of issue. The babies we are usually 
helping to  bottlfeed more safely may have state control issues, or other 
neuro issues from  being early, or even from the current assaults of a "normal 
birth" around here.  But they may not be permanent issues that are obvious 
enough and challenging  enough to bring in an SLTor other Early Intervention 
specialist. In this  situation, I contacted her because a formerly thriving 
baby ( but with  a mother in misery) had precipitously seemed to lose the 
ability to  get enough to eat at breast, or to sleep normally, and was 
faltering in weight.  I think that because we are the one profession was  actually 
understands deeply and thoroughly what physiologic and emotional  normal is 
for human little ones, we look with different eyes. A  baby who can 
bottlefeed well enough not to fall off growth  curves  pretty much gets passed 
over, no matter how many other,  sometimes obvious, other times subtle, issues 
we see.  Even though  this baby was later evaluated and found to be of 
"normal tone" and not qualify  for services, I have serious thoughts that in the 
future he will be back in EI  for something that wasn't big enough to see 
now, but will become more obvious  later. I feel like I see this more and more. 
Even though Wolf and Glass's book  is '92 it still seems to be the standard 
for treatment, and again these babies  are not "normal" babies who got off 
track and we might be able to help them get  back on with our supports, 
information and temporary interventions. The titles  may be very potent: Wolf 
and Glass's book is Feeding and Swallowing Disorders,  Cathy's is Supporting 
Sucking Skills in Breastfeeding.... two different sets of  eyes looking, and 
what they are looking for, two different views of what the  outcome could 
be: safer bottlefeeding for children  with disorders vs normal 
feeding/nurturing at breast  with all  the tied-in mothering that can go with it. It's not 
that SLTs are against  breastfeeding, but their profession was born in a 
time when mostly no one was  thinking of a baby breastfeeding as a normal 
developmental skill worth fighting  for, whereas ours was born of the idea that 
breastfeeding (like bipedalism) is a  normal developmental skill for humans 
which our bodies are well-adapted to  complete ( unless something major is 
standing in the way) and therefore always  thought of as the "default" goal. 
Although we live in a culture that still does  not accept this, it is a part 
of our view of normal human skill acquisition, and  bottlefeeding or other 
assistive feeding scenarios are what we settle for  when the norm cannot be 
achieved. The fact that bottles are widely thought of as  normal and 
necessary make our roles harder ( witness the new ads for American  Reunion, where 
Alyson Hannigan's character indicates her motherhood status by  holding a 
bottle in the photo.) Perhaps someday Wolf and Glass and Cathy Genna  will 
co-write a book!
 
One can dream...
Peace,
Judy  

Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
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