Bryna writes:
Baby has what the ENT calls a "borderline" posterior tongue restriction,
but is gaining weight well and mom's nipples have healed and the dyad is
breastfeeding very well, despite "small" latches as reported by mother.
Mom is due to return to work in October, and after 7 weeks and
establishment of good breastfeeding, the midwife suggested introduction of bottles.
Family complied, but baby refused. For the past 3 weeks, family has been
working toward this goal, as baby is now 10-11 weeks.
We have tried paced bottle feeding baby while skin to skin with the
father, mother left the house, tried introducing a straw with some limited
success, tried feeding baby whilst she was upright propped on dad's knees, making
sure to use bottle to stimulate baby's high-arched palate.
~~~ Although this baby may eventually accept a bottle from whoever will be
caring her while mom works at home, there are several factors that may be
involved in what they are seeing now. Two possible solutions are being ruled
out before they are even really observed: cup feeding and reverse cycling.
This may or may not change if baby continues. Another thing is that babies
with high palates and/or posterior restrictions often have several things
they are dealing with that make bottlefeeding feel either unsafe,
uncomfortable or just possibly weird. The mom's breast conforms to the shape of the
palate, but no artificial nipple does this. It can "poke" a baby in the
"naive" or very sensitive palate area and be a negative sensation for this
baby when it might be fine for another baby. Another issue is that a tongue
restriction can mean that a baby does not have the full range of
motion/grooving/whatever skill to control milk well when it comes out of anything other
than mom's breast. The breast-mouth interplay is different in both
sensation and stability, because baby's mouth is filled and conformed to, so this
baby may be reacting to this "intrusion" or a lowered ability to move and
control milk transfer in a way that feels comfortable and safe. Some babies
will overcome these negative sensations in time, others we are simply
asking for too much ( we still live in a society where bottles are seen as
normal and families often don't realize that this foreign object can be an
uncomfortable thing which feels weird or unsafe. ) Perhaps helping the family to
understand this, they will understand their options for this baby better. I
hope this helps, it's a complicated issue and often does create problems
for families who think this should be so easy, or they've done something
wrong. I've seen only two or three little ones who refused bottles initially,
and never changed ( in about 25 years) and the moms actually quit their
jobs and worked at home and were available for baby to breastfeed. The time
when this was the only option, in retrospect, was short. This baby may end
up cup feeding, reverse cycling, breastfeeding only til ready for solids,
who knows...
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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