I'm so overwhelmed with all the help you are all providing -- again, thank
you!!

The test was done with baby sitting upright, using a bottle, which may
have even been the first bottle he had ever received -- another reason to
question its results.  I wondered if they even offer to do the study at the
breast; of course that would seem logical to me but I'm a breastfeeding
advocate; is this something that can be done with u/s or do they need the .
The baby never showed any outward signs aside from being a very noisy eater
at the breast.

Mom said that she never was given the reason that the aspiration was
occurring, if that was indeed what was happening.  She said they didn't see
any structural issues and they settled on the diagnosis of immaturity.  They
called it silent aspiration, that doesn't show any outward symptoms until he
has swallowed a lot into the lungs, which they deemed too dangerous to
risk.  She has been SO tempted to just put baby to breast because he looks
and acts just fine; however she watched him aspirate into the lungs on the
screen during the test but you wouldn't have known it by just looking at
him.  She said that she watched the milk "pooling at the opening before it
went down."  I've seen these ultrasounds at various presentations and I just
don't have the knack to recognize what's normal and what is abnormal because
the segments were not shown simultaneously; I wonder if she was even seeing
something abnormal or completely normal (???).

I observed mom feeding baby last week, sitting upright as I suggested but
she is tipping the bottle up higher than I had suggested; baby was
comfortable, paced himself with relaxed pauses, looked around as he fed,
never even got moist-eyed, leaked milk, or showed any other signs that might
suggest he's struggling.  Thanks to mom's fantastic milk supply, she pumps
all the milk she needs and rigidly adheres to her pumping schedule to
preserve the supply.  They're planning to redo the test next month; I'm
going to see if I can get invited along :^D

I'll re-read Chapter 1 of your wonderful book, which I carry around
constantly and is dog-eared with Post-Its of various colors poking out at
the edges, making it look far older than it really is!

As for the other thickeners, I wondered about the effects of introducing
foreign proteins so early in life, particularly gluten-containing foods like
barley -- does this increase later food sensitivities/allergies?  If the
milk isn't thickened to the proper consistency, does this increase the risk
of infection if it does end up aspirated?  I wondered if this is further
down on the list of priorities to address, or if it factors into the choices
of thickeners.

Thank you all again for your help.  This mom is so grateful for the
information, and I'm learning so much.  I welcome any other suggestions.

Debbie Gillespie
IBCLC, LLLL
Sweltering Tempe, AZ


On Tue, Jul 14, 2009 at 11:34 AM, Catherine Watson Genna, IBCLC <
[log in to unmask]> wrote:

> First off, was the baby aspirating DURING BREASTFEEDING? Were there
> clinical issues (recurrent pneumonia?). Often, a baby who aspirates while
> being bottle fed on a videofluoroscopic swallowing study is taken off the
> breast, even though they are doing better at breast, so milk can be
> thickened. There are problems with nutrient absorption with thickeners
> according to research studies, and thickening is not all that effective
> either. Lisa Sandora (speech therapist and IBCLC) and I cover this in
> chapter 1 of Supporting Sucking Skills in BF infants, which you can read
> online at Google books (so no commercial intended). The refs are there too.
>
> If the baby was not aspirating during bf, or was not having clinical
> problems due to aspiration, then management changes to improve baby's
> ability to handle flow may be sufficient. You can help with that! If the
> baby was having clinical problems from bf, then perhaps feeding with
> thickeners is justified.
>
> Catherine Watson Genna, BS, IBCLC  NYC
>
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