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Wed, 4 Jul 2007 17:50:57 -0500 |
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Jaye, The head sounds like this baby needs to be seen by a craniosacral
therapist and a physical or occupational therapist. I would like to see
if baby can do better with more flow at the breast -- but your
description of aspiration bothers me. I find that babies used to bottles
do not suck at the breast. They are used to swallowing the flow off the
bottle nipple. It "looks" like sucking but if they do the same thing at
the breast, they remove nothing.
What kind of bottles is mom using? I might suggest Dr Browns or a
Habermann Feeder if baby is going gulp gulp gulp gulp then a quick and
deep gasping breath on the bottle. Or pacing with a standard, non
hospital bottle nipple, with only 3-4 sucks or jaw movements before
removing the bottle nipple and placing it on his mouth. I like to watch
these babies bottle feed as it can tell you a lot. Like if they gulp and
gasp or if they are slow or if they can't grip with one of their lips or
if they aspirate on the bottle. Bottle feeding problems are a huge red
flag that gets the pedi's around here interested. If it is just breast,
most pedi's ask mom in a negative way if she is sure she wants to go to
all the trouble of seeing a SLP, etc.
That double nipple bottle (breast flow??) helped one of my babies who
had trouble with swallowing. He did better on that bottle and choked
less. But it can be tricky to put together.
With babies that seem to have oral motor issues, I like to do several
test weights at the breast to see at what point baby stops removing
milk. I find that SNSs don't usually work right with these oral motor
babies, I guess their sucking is so ineffective or poor. But at the
point where they are on the breast and not removing milk, I take them
off and feed another way (usually bottle because we have to feed them in
the easiest way as their weight gain is poor and feedings are so slow.)
If you put these babies on a wide based bottle nipple and they can't
grip with their top lip, this shows weakness and I always point that out
in my HCP report as something I observed.
Also, I work with a lot of recessed chin babies because I seem to be the
only one that can latch them on. (The trick is a deep asymetrical latch
with the chin smooshed right in and the nose out, head tipped back a
tiny bit, and body of baby tucked into mom's body. You put them on going
in front ways or the old style and they can't latch right because their
chin is hanging out.) I also see a lot of what I suspect are posterior
tongue ties with those very recessed chins. One red flag is when the
baby's top lip hangs out over the bottom lip with a gap or air space
between them -- they don't meet at normal resting position.
This mother is fortunate to have your support and encouragement. She
deserves a medal!
Kathy Eng, BSW, IBCLC
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