Sometimes I see babies who appear to (in some deliberate way) self-limit
their intake.  There is always a reason for this, generally related to the
fact that feeding causes discomfort or stress.  I have found that there are
some common features in these cases:
1. reflux (eating produces a painful aftermath)
2. swallowing dysfunction (feeding produces an immediately uncomfortable or
frightening result -- micro-aspirations or a sense of "drowning")
3.  mis-match between length of maternal nipple or bottle teat and length of
baby's palate (causes immediate distress by repeatedly triggering a gag
reflex)
4.  poorly timed suck-swallow-breathe rhythm which can't keep up with rapid
milk flow (baby can manage to stay with the rhythm for a certain period of
time, but then "fatigue aspiration" becomes an issue and baby selects to
discontinue the feed too early to support robust growth)

All these issues are made worse when feeders disregard stress cues in the
body language of the infant and try to keep encouraging baby to feed past
the point in the feed when the stress-cues begin to manifest.  A
rest/recovery period is called for to allow the baby to recover respiratory
stability.  Pacing (see Wolf and Glass's books and read the work of Margery
Palmer) is a good way to help the infant feel restored confidence in
feeding.  Baby may need a swallowing study if this has not been one of the
tests done so far.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

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