Before I go no-mail and head off into the sunset on holiday, I wanted to
bring you all up to date on the continuing saga of my client, a 4 1/2 month
old with complex eating, sensory integration, developmental and maybe
neurological or genetic problems.
I am happy to report some progress. About two weeks ago, we introduced new
oral-motor exercises using a small vibrator, and his lip and facial tone has
improved somewhat. Baby seems to actually enjoy the input (he smiled!), and
mom is delighted. By adjusting the feeding schedule to 4 hourly (and not
focusing so much on his painfully slow weight gain), we find that he is
taking about 100 ml per feed, in about 30 minutes, a marked improvement. He
still is not exhibiting age-appropriate suck and swallow behavior, but he is
managing the artificial teat better. He gained 100 grams last week.
Thyroid function tests are normal. Urinalysis normal, no signs of infection.
We have secured a referral for the baby for a comprehensive OT, PT, SLP, and
developmental assessments, which will happen in the next few weeks.
We are still waiting for the results of the chromosome testing.
Family has been referred from neonatologist to a pediatrician for ongoing
care. In addition to ruling out genetic abnormalities, baby will be screened
by the above experts for developmental delays, sensory integration disorder,
and autism spectrum disorder. Depending on his progress and diagnosis, we
have also lined up an infant psychiatrist to evaluate him if necessary. A
swallowing study, reevaluation for reflux, and lower GI tests are also being
considered.
Treatment by the osteopath continues, and he notes good progress in several
areas. Unfortunately, the palate is not one of them, but he reports that
minor progress is occurring. Baby is still quite defensive of the oral
cavity, and will only take a finger to the depth of a fingernail. Mom
remains hopeful that several more treatments will help. He still won't even
consider the breast, but mom is pumping and resigned to continuing that for
the near future.
Mom has requested a nutritional analysis and creamatocrit be done of her
milk. I'm working on finding someone in Sydney or Melbourne who can do that.
(Oz Lactnetters, if you know someone, don't hesitate to speak up please!)
Obviously, this is the beginning of a very long road for this family, and
other than continuing to support the mom, I feel that there's not much else I
can do in terms of feeding. But I feel good about being able to round up
this interdisciplinary team and get them talking to each other. Many thanks
to all of you who offered suggestions and thoughts along the way.
Barbara Ash, IBCLC
Canberra, Australia
***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
