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Date: | Sun, 22 Jan 2006 23:13:20 -0500 |
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When babies are agitated and miserable about feeding it is often from a
swallowing disorder. How about a videoflouroscopic swallowing study for
this baby?
You don't mention anything about his coordination of swallowing and
breathing. Low tech things that can be done include cervical
auscultation (put a stethescope under his chin or on his neck to listen
to his swallow. Listen for delays in swallowing, gurgly/bubbly sounds
that mean that the pharynx is not clearing (incomplete swallow), stridor
that means either penetration (milk coming into the area of the vocal
folds suddenly) or narrowing of the airway; or increasing congestion
that means that milk is getting into either the nasopharynx or
hypopharynx. Lousy swallowing can be from poor bolus control due to a
tongue tie, or structural issues, or functional/neurological issues.
Many of these are genetic.
Noisy rapid breathing after a few sucks means a cardiorespirtory
inefficiency. Panting is a severe sign, often babies with undiagnosed
cardiac problems pant after a suck or two.
Also assess for color changes, especially around the lips and in the
hands and feet. A healthy baby remains pink during feeding.
Look at the baby's fingers. Sometimes slight differences in the hand
goes along with cardiac malformations.
Once we have some idea what's happening, we can sometimes figure out
ways to help. Certainly helping the baby control the flow of the feeding
is one place to start.
Catherine Watson Genna, IBCLC NYC
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