This is why I love the design of the sn feeder.  NO drips when baby is not actively feeding.  I have tested this feeder and it is GREAT for teaching paced bottle-feeding.  It is not just a device for cleft palate babies.  Karen's test are accurate as I've repeated them. I strongly urge folks to check these out.  In my observation with the SLP, bottles require negative pressure to pull fluid from them.  The amount of pressure required depends on the size of the hole in the nipple.  Firmer nipples allow some compression to remove milk, softer ones do not.  So - babies who have weak sucks may get milk from standard bottle nipples if the hole is big enough to allow a flow or, if the nipple is firm enough and the tilt strong enough to keep fluid down in the nipple, with compression.  But ANY nipple that has a straight hole (no slit valve) will leak.  The teat with a slit in it, does not drip, even without the membrane!  Quite surprising when I discovered this! 

-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Karen Gromada
Sent: Saturday, May 02, 2009 5:50 PM
Subject: Re: paced or cue based bottle feeding

I have great respect to everyone who has added info to our discipline of lactation consulting/BF support. And I think (I'd hope) all of us want to respect the infant's cues for pauses (and cues re: other behaviors), which is a cue that a baby needs a break in coordinating suck-swallow-breathe and is feeling overwhelmed re: airway protection. Still, it's usually not necessary to take a bottle teat out of a baby's mouth to do it - and doing so may reinforce oral disorganization. For the baby seeing a LC because there's some issue with oral organization, I figure we all want to avoid adding any iatrogenic factors. The technique I've now learned from Lisa S (MA, CCC-SLP, IBCLC) and a pedi OT  involves either: 1. leaning baby forward (with bottle still in mouth) or 2. angling the bottle toward the corner of the mouth, "pinching" off flow. If done appropriately, neither disturbs placement of the teat in the mouth. When needed after a reasonable pause and infant's cues indicate comfort, many tilt the teat toward/against the palate to "remind" a baby he/she may want to eat again.
As per BF, most flow comes out of the bottle with negative pressure. Unless using a infant-feeding bottle having inappropriate flow in the first place, the amount of dripping usually is very minimal and the occasional drop would add little to an airway threatening bolus during a pause.

Don't know about others, but I'm always learning new strategies and new ways of thinking (and more about oral physiology) -- and I've loved having the opportunity to learn from therapists in other disciplines. Still have sooooo much more to learn. And for the therapists who aren't also IBCLC, they're dealing almost always with babyies on bottles and aren't thinking re: BF as "normal feeding" so they also love learning from us re: "normalcy" of the babies they see transitioning to breast and likelihood of an underlying issue if baby isn't able to do it. Such collaborations are so win-win...

K

On Sat, May 2, 2009 at 5:59 PM, Elizabeth Brooks <[log in to unmask]> wrote:

> Karen -- I think your teachers and Cathy Genna are on the same page.  
> She isn't saying to pull the nipple/teat out of the mouth to "create" 
> a pause ... but rather to take advantage of the pauses the B naturally 
> will offer in the course of a feed.
>
> If I understood it all correctly, Cathy was telling us that the idea 
> is to respect the natural pauses that the baby takes.  In the course 
> of any feed
> -- at breast or otherwise -- a baby may want to stop, and rest, or 
> ponder life, or take a breath, or organize a bolus for swallowing 
> (remember -- these are babies whose breastfeeding skills are already 
> compromised, if we are using paced bottle feeding as part of the therapy).
>
> The idea of having the nipple/teat pulled out and rested *on the lower 
> lip* was to avoid stressing that baby into now having to wonder "What 
> happened to dinner?  I was just getting the hang of this and they 
> snatched my plate away."  Leaving the nipple/teat within range of 
> smell, taste and feel is much more akin to the baby who says latched, but not suckling, on a breast.
>
> I have heard others IBCLCs say they prefer to use a technique where 
> they "tip" the nipple/teat toward the roof of the mouth during the 
> pauses, while keeping it in the mouth.  This avoids having those drips 
> that come out of the bottle ... landing on the tongue when Baby least 
> expects it or can handle it.
>
> Is this compatible with the teaching you heard?
>
> --
> Liz Brooks JD IBCLC
> Wyndmoor, PA, USA
>



--
Karen Gromada
www.karengromada.com/
http://www.marchforbabies.org/karengromada

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