This is only my second posting, but I too would like to welcome David Page.
A professional person like yourself is always valuable in our field.
Thankyou for the interesting infomation to date.

I have a couple of questions for you:I reiterate what you wrote "Sucking a
bottle/pacifier/finger constricts and deforms the jaws which surround the
airway with upward and backward forces acting against proper down and
forward growth. Tongue and swallow patterns become abnormal, and oxygen
saturation drops as mouth breathing increases"

What is your opinion of fingerfeeding? As I look after babies with Down
Syndrome, and babies with cleft defects, I do use fingerfeeding, the length
of time this is used can vary from a few days to a few weeks to months.
This latter being used for a baby with a total cleft palate of the soft and
hard palates, as a way of getting the baby off the naso-gastric tube. She
never learn't to breastfeed or bottlefeed. She fingerfed for 9mths, then
drank from a cup, which we had introduced earlier but without success. Have
I done something wrong here? It is my experience that Down Syndrome babies
learn to feed at the breast quicker if fingerfeeding is used rather than
naso-gastric feedings. Also fingerfeeding is used often here in Switzerland
for term babies, who require extra fluids, due to medical reasons,thus
avoiding nipple confusion.

My next question: What do you think of the use of pacifiers in premature
babies, especially extremely small ones under a kilo in weight? As far as I
am informed the hard palate is easily misshaped in these babies, and other
premies of course too! Is it to assume that the smaller the baby the worse
the damage? What can one do when the staff don't have time to soothe the
baby and give him/her a pacifier instead? I saw a 25 weeker (now 40 weeks)
the other day with massive nasal breathing problems, nasal prongs in the
nose for oxygen, a very highly arched palate, and a pacifier in her mouth,
the latter is surely a hindrance! BUT what can we do, it is sometimes a
very viscous circle!

David I would very much appreciate your thoughts, and knowledge in this
area.

Kindest regards. Kerri Frischknecht,RN,RM,IBCLC.

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