When babies have this much difficulty feeding, there are several things 
to look for:

- cardiorespiratory issues - baby will use short sucking bursts (3-5 
sucks), long respiratory pauses, and may have noisy breathing or panting 
in those pauses. Babies with collapsing airways may have stridor during 
breathing (a high pitched, squeaky sound). Managing flow helps these 
babies. Head extension and a prone position for feeding helps if it's 
respiratory.

- swallowing difficulties - baby will have stridor during the tail end 
of swallows, or will sound gulpy, hold the breath when swallowing, 
and/or breathing begins to sound wetter and harsher as the feeding 
progresses. These kids are aspirating. Again, pacing and prone 
positioning help. Cervical auscultation is a good tool for listening to 
baby's swallowing, just use a stethescope (a neonatal head is ideal, but 
a cheap adult one works too) under baby's chin and listen. Swallowing 
should sound like a crisp, biphasic sound (glug-ug). If there's 
bubbling, whistling, rattling, stridor, or a delay in getting milk out 
of the airway, you'll hear it with a little practice. You can also hear 
the coordination of swallowing and breathing. We want babies to swallow 
in breathing pauses, and breathe in between swallows.

- neurological/genetic issues - there are many syndromes that cause 
feeding problems. Any baby who has problems feeding deserves a good 
examination by physicians as well as therapists. A genetics workup is 
helpful for infants with feeding problems, especially if they have low 
muscle tone and slow growth as well. There are a few syndromes that 
cause the baby to be large at birth and grow very poorly afterward. What 
one does to support the feeding depends on the baby's specific difficulties.

If you have a more detailed assessment to share (even of the bottle 
feeding) I'd be happy to offer more suggestions.

Catherine Watson Genna, IBCLC  NYC

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
Mail all commands to [log in to unmask]
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or [log in to unmask])
To unsubscribe: unsubscribe lactnet or ([log in to unmask])
To reach list owners: [log in to unmask]