I think that dysfunction in the respiratory phase of the
suck-swallow-breathe cycle tends to be under-recognized in the etiology of
feeding problems.  (As always, the point must be made that normal babies
feed normally, and they pace sucking-swallowing-breathing just fine and can
safely be ignored).

 Dysfunctionally feeding babies can have weaknesses in any of the 3 areas of
the S-S-B triade.  These weaknesses can be the result of injury, illness,
muscular tension/tone issues, prematurity, sensory issues, or neurological
deficit.  They may be temporary or enduring problems.

 When babies can't breathe well while feeding, they act frantic at breast,
make a lot of noises, and fatigue early.  Their breathing may sound wet
during or just after feeds.  They hiccough or pant when they pull off,
trying to do 'catch-up breathing'.  This is because they essentially hold
their breath while feeding, gulp as quick as they can, and then pull off to
re-organize respirations.  This style of feeding promotes a lot of air
swallowing, crying, and scant evidence of satiety or feed enjoyment.

Many of these babies do even more poorly on bottles unless mom has purposely
or accidently chosen a teat with a slow flow rate, in which case they may
really prefer it because they can pace swallowing with breathing better.
This is esp. true if mom's letdown is forceful.  They may also learn to
clamp off  or crimp a soft bottle teat and flare their lips at the corner of
their mouth (breaking the seal) in order to suck in a bit of extra oxygen
that way.  At breast, esp. if mom holds them in tight, they may feel
overwhelmed.    Using a slightly softer breast helps.  Counsel mom to allow
baby to come off if needed.  Realize that all the clicking is a break in
seal which is a compensation baby may be using to control the flow.
Understand that all this is abnormally expensive in terms of energy and that
work of feeding goes up, intake prob. goes down.  Short, frequent feeds are
good. Use feeding positions which help baby cope with flow.  Don't bend baby
forward over the waist band of the diaper to burp or wind.  This places too
much pressure on the abdomin which may be distended from air swallowing.
Babies with this problem often have reflux issues which improve when more
attention is paid to helping the feeding go better vis a vis respiratory
function.

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

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