Greetings...At the request of a pediatrician, I met with a Mom and baby
who had been seen for their 2 week visit.  Baby has been nursing well
and was above birth weight.  Mom's report is that "baby stops breathing
sometimes while he is nursing".  Ped did an exam ,and passed an NG tube
to the stomach to assure patency.... all OK.  As I watched this baby
nurse, he made a lot of noise.  It wasn't smacking noise, it sounded
more like grunting and/or humming.  Several times during the feeding, he
paused briefly at breast and sounded like a   snoring  person with sleep
apnea... almost unable to take a breath through his nose (which was not
congested).  Mom reports no color change during any of these episodes,
and she simply blows lightly on his face to get his breathing back on
track.  The entire nursing was very noisy, and clearly a good transfer
of milk..
  Upon oral assessment, his palate seemed normal behind the upper gums,
but seemed to flatten out halfway back.  (I wish I could draw a picture
for you.)  My impression is that the baby is having a problem with suck,
swallow, breathe because the milk is flowing out very quickly and
hitting that flat part of his palate and spraying all over the place.
My suggestions to Mom included using positions helpful in the case of an
over-active let-down with his face looking down on her breast.  I'd love
to have an ENT consult, too.  Do you agree that might help sort things
out?  Would our pediatric OT pick up on what's happening here?  Your
feedback and advice is welcome!!!!

Susan Wirtjes RN IBCLC     Waterloo, Iowa
"What you permit, you promote."

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