In a message dated 03/27/2004 9:05:31 PM Pacific Standard Time, [log in to unmask] writes: > How do you tell when sneezing, hiccoughing, gagging and vomiting are stress > signs vs just a bodily function? Christine, I was not at the Rush conference, but I'd like to offer my thoughts....In fact, today I helped a mom breastfeed her preterm baby who was discharged from the hospital yesterday. The baby had been to the breast twice and taken 14 and 15 cc's. At today's consult, baby transferred 28 cc's at the breast, and I'd base the most logical reasoning for this baby's improved intake at the breast as determined by appropriately reading her stress signals and interpreting her behaviors for the mom so as to educate her as to signs of readiness to feed versus signs of stress/distress. As this preterm infant latched onto the breast, she initiated the feeding by exhibiting a rapid suckling pattern for approx. 2 minutes until mom's let-down, and then she proceeded to long jaw excursions related to the expression phase. As she willingly nursed, I talked to mom to explain how her baby's appearance was related to her ability to coordinate suck/swallow adequately at the breast. I was aware that this mom was told in the hospital setting that breastfeeding was not tried due to the baby's apneic spells on bottlefeedings. Despite educating mom on the research findings demonstrating less distress at the breast, mom still felt concerned about stressing her baby out at the breast. Teaching her to read her baby's cues is more effective than portraying myself as knowledgeable and contradictory to earlier statements given by the hospital staff. So, as baby fed at the breast, I spoke to mom about baby's relaxed appearance - her relaxed forehead, her eyes shut but not tightly, her fists closed but not tight, nor exhibiting splayed fingers, and long jaw excursions with periodic pauses for breathing, and her apnea monitor never alarmed (I never figured it would!). Baby persisted with her feed at the breast until she spontaneously detached during an obvious let-down as mom's milk spray released, and baby appeared satiated. Well, when the mom proceeded to attempt to put the baby back onto the breast, the baby then responded with splayed hands, a bit of choking; enough that mom said it sounded like there was some fluid at the baby's throat, a very small spit-up, and a facial grimace. I counseled the mom on the interpretations of these signals as stress signals and the reasoning behind respecting these signals to meet the baby's needs. After allowing the baby time to regroup for a few minutes, the baby exhibited early hunger cues by smacking of lips, opening and closing her mouth, and getting her fists to her mouth, so I then suggested the mom try to re-latch her baby onto the breast. Because we read the stress signals, and paused until baby showed readiness again, the baby latched onto the breast, and proceeded to breastfeed effectively again. In response to the question as to when are hiccoughs and gagging/choking just merely what they are versus stress signals has to do with the big picture. One must assess the baby for other physiological signs of stress versus non-stress. We understand that a preterm baby is different than a fullterm baby. A preterm baby could merely hiccough and that can be denoted as a stress signal. But, merely hiccoughing in a fullterm baby may simply be that; if the baby has a relaxed forehead, relaxed fists, etc., etc. versus the fullterm baby who extends his/her head, twists his/her torso, defecates, squirms, grimaces, etc., etc., and therefore may indeed be demonstrating signs of stress. I believe many times babies are stressed out by forced feedings at the breast in the early days. It behooves us to educate moms not to force babies to breastfeed, but to learn to read early hunger cues versus stress signals. Being permissible to follow babies' cues gets them to latch onto the breast more readily, with less oral aversion as an outcome. When feedings are forced in the early days by ignoring the gaggings, hiccoughings, and other stress signals, these babies often exhibit refusal of the breast and/or dysfunctional sucks once home with the mom. Carol Chamblin, RN, MS, IBCLC Breast 'N Baby Lactation Services, Inc. St. Charles, IL *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html