In a message dated 9/12/02 2:01:56 PM, [log in to unmask] writes:
Our NICU has brought in an SLP (speech language pathologist) from another
city to write our feeding protocols.  She is using rice cereal and
SimplyThick mixed with both EBM (expressed breastmilk) and ABM (artificial
baby milk),then bottling.

<< We have a perinatal dietitian who is concerned about this, as are the
IBCLCs.  These are babies without a diagnosis of GER.  They have been
observed choking when given supplementary bottles.
 >>

Oh my, how about giving them a slower flowing bottle.  Premies frequently
choke when the bottle flows too fast. .In our unit we don't even thicken
feeds for babies with GER We are in the procees of removing all yellow and
red formula company nipples from our intermediate care nursery, although
somehow they keep sneaking back to the shelves.  Somebody just needs to slow
down the bottle for these babies and watch their cues.  Better yet put them
to breast and wait unitil they are older to offer the bottle.  I can't think
of any justification for thickening feeds unless baby has a documented
swallowing problem.  I'm surprised the neonatologists have turned over
nutrition to a speech and language pathologist. Any NICU nurse can tell you
that premies choke on too fast a flow. and that handling the flow is a
developmental issue. If a baby can only take enough milk from a very fast
flow bottle, then he isn't developmentally ready for a bottle yet. If at an
appropriate age baby still has not outgrown this, then they are ready for an
evaluation.  This is a hot button issue in our unit right now, so you can see
I have a lot of energy on it.  Most nurses are not trained to bottle feed in
a manner which is best for the baby--they just want to get the job done
fast--I know I was one of them once.

Kathy Boggs, RN, IBCLC
Mountain View, CA

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