i decided to post about this conference i went to for several reasons.
flaming the presentation is NOT what i am aiming at. so please understand
that this is just my reaction to what was discussed. the title was
"evaluation and treatment of oral feeding disorders in the nicu and after
discharge." this was given by marjorie meyer palmer, who teaches her NOMAS
system. she is interesting and funny and was able to hold attention for two
solid days of talk, which is a real accomplishment.

i wasn't clear about the nature of this talk from the brochure, but some
persons had urged me to take the nomas training course, so i assumed this
would be at least in part about that, which it was. i am also quite
interested in what is going wrong in the nicu and how it affects
breastfeeding later. i have some specific questions about the mechanisms of
breastfeeding that i hoped would be answered. you know what? i don't have
many questions about bottlefeeding; i think they were all answered already.
but i did get a bit more information about situations in which bottlefeeding
is not only wrong, but dangerous, which has been discussed on lactnet before.

this course included first a sort of reduced version of the nomas training.
that is "neonatal oral-motor dysfunction assessment scale." this is an
elegant answer to the problems faced,apparently, by people in this field when
needing to assess the competency of a baby when feeding. the field i am
thinking this is aimed at is OTs, speech pathologists, NDT, etc. not us! it
is very well-researched tool and marjorie says that it is possible to get
100% accuracy in evaluating babies up to age two months with it, and she
includes breastfeeding and bottlefeeding babies. she will say that it is more
difficult with breastfeeding babies because you can't evaluate the rate of
flow of milk.

i would say that the entire system is suspect because it is based on
bottlefeeding as the norm. with this system, it doesn't matter what type of
nipple or flow the baby is using as long as the same nipple is used to
evaluate non-nutritive sucking and nutritive sucking. i am not ready to say
that there is any such thing as completely non-nutritive sucking when it is
at the breast (just as i don't believe in "dry breast sucking" except as a
ploy to get babies at a breast under a prevailing belief system), but of
course, when a baby sucks a pacifier it is non-nutritive. so i am not ready
to accept a system as valid, especially for breastfeeding, when it is based
on bottlefeeding.

she also states that it is not possible for a baby to be capable of feeding
before 38-40 weeks, but since this refers only to bottlefeeding, and it was
not clear to me if she has a firm feeling about breastfeeding before that
date, and it wasn't really addressed, this too was just another aspect of how
the norm is based on bottlefeeding.

i gained a good understanding of the difference between sensory and motor
problems. this is really important to what we are looking at in babies. i
learned a great deal more about reflux and what she thinks the reasons are
for the oral or feeding aversions babies develop. this is an important area.
"real" reflux is a terrible problem (as opposed to "diagnostic convenience"
reflux).

MMP says that there is nothing in the literature to connect procedures in the
nicu with later aversions, mostly due to the difficulty of limiting the study
in such a way as to show a direct relationship. but she feels quite strongly
that many of the things done routinely to babies, particularly in the nicu,
cause aversion problems. i agree, this is an important area.

she mentioned wanting to do such a presentation for lactation audiences. i am
going to encourage her to do so, but only with a lot more education. her
current presentation was so shocking to me when it became obvious that the
entire profession is based on bottlefeeding as the norm.

there were some appalling remarks made by members of the group, showing that
knowledge of breastfeeding and what we have lately been calling "parenting
advice"  is largely unknown to them. but i will say this, that was a group of
people who mostly would not have to be convinced about tongue tie being a
problem. they know it very well, and some were lamenting that they couldn't
find anyone to clip a tongue tie in a baby.

we need more ecumenism in these professions. we might as well be on another
planet. hey wait! we are! dang.

carol brussel IBCLC
still decompressing from this in denver colorado

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