I am forwarding this message from Barbara Wilson-Clay.  I sent it yesterday,
but it seemed to get lost in cyberspace somewhere.  So my apologies if it
suddenly reappears and this gets posted twice!  ;-)
-Linda Hill








Hi Everyone,


Just responding to the comments on paced bottle (or cup or spoon) feeding
which someone forwarded.  Paced feeding or "pacing" is a term already in use
in the OT literature (article cited below). Therefore, using an established
term with a specific clinical definition has much to recommend it in terms
of inter-disciplinary clarity and communication.



Pacing techniques simply refer to a feeder's responsibility to allow the
eater to have a moment to pause between swallows in order to take a breath.
The pace at which babies are fed can contribute, in fragile infants, to
feeding problems that materialize later (e.g. when they start solids).  And
yet, remarkably little attention has been paid to old traditions with regard
to bottle feeding.  For instance, if you hold a bottle so there is no air in
the teat/nipple, the upshot is the gravity drop is so severe the baby is
forced to chug the fast flowing liquid.  It is better to hold the bottle
parallel with the flow with lots of air in the teat so the flow rate is lots
slower.  Never mind air swallowing-just burp after feeding.



The speed of eating is also implicated in obesity, if we are to believe the
diet books.



I hope we will adopt the concepts borrowed from other disciplines on how to
ensure the humane feeding of people who cannot feed themselves.  It doesn't
matter what tool we use to deliver the food; only that it be done
respectfully and with attention paid to maintenance of stable respiration in
the patient.  To put the conversation into perspective, consider how in the
movies, for example, a director may show someone rapidly shoveling food into
the mouth of someone who is very young, very old, or helpless. We are meant
to see this as insensitive behavior.




I wrote a CE module for Dr. Hale on the subject of pacing, and we talk a lot
about it in The Breastfeeding Atlas.  For an article that describes infant
outcomes of pacing vs not pacing, see:



Law-Morstatt L, Judd D, Snyder P, Baier RJ, Dhanireddy R:  Pacing as a
Treatment Technique for Transitional Sucking Patterns, J Perinatol
2003;23:483-488.



A few other good articles:

Dowling D, Meier P, DiFiore J, et al:  Cup-Feeding for Preterm Infants:
Mechanics and Safety, JHL 2002: 18(1):13-20.

Kelly B, Huckabee M, Jones  R, et al:  The early impact of feeding on infant
breathing-swallowing coordination. Respir Physiol Neurobiol 2006; Epub in
advance of publication  doi:10.1016/j.resp.2006.09.007
<http://dx.doi.org/10.1016/j.resp.2006.09.007>



Palmer M. Identification and management of the transitional suck pattern in
premature infants, J Perinat Neonatal Nurs 1993; 7(1):66-75.





Barbara Wilson-Clay, BSEd, IBCLC, FILCA


12710 Burson Dr.


Manchaca, TX   78652


Ph:  512-292-7227   Fax:  512-292-7228


www.lactnews.com <http://www.lactnews.com/>






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