Hi Jennifer,
The hard and unfortunate reality is that some infants really struggle to
feed normally. I once presented a similar case to Willow Reed (Niles
Newton's daughter, who was my immed. superviser in the PL Dept.) and Julie
Stock. I said something like: "There must be something I'm not seeing.
How
would they have gotten this baby to breast in ages past." Both looked at
me
as if I were totally naive, and said: "Well, in the past, babies who
couldn't feed simply died." We really have forgotten the terrible infant
mortality that occured and still occurs outside the developed world.
Infancy is a very vulnerable time and many babies die during this time
because they are non-viable feeders. Here we can intervene with therapy
and
alternate feeding methods, but there certainly are babies beyond our best
skills who will only bfeed after intense therapy or maybe never (in spite
of
everyone's best efforts.)
Breech babies are often difficult to feed. Because of their intrauterine
position, wedged up so that they cannot turn and present normally, they
often develop torticollis or other muscular tension that results from
inhibited freedom of movement. Something I'm becomming real interested in
is the role of the tongue in shaping the palate. If a baby in utero is
hyper flexed at the neck (tuck your chin tightly into your neck or twist
your head sideways and see what your tongue does) he may not be able to
comfortably rest the tongue so that it approximates and helps to properly
shape the palate. I once put my finger into the mouth of a 2 mo. old with
FTT and, feeling the high, arched palate said: Hmmmm. I rarely feel a
palate shaped like this unless the baby is tongue-tied." It didn't occur
to
me that a two month old (foster child of a Leader) could have gone this
long
with no one observing a tongue-tie, but after feeling the palate, when I
looked, there it was. Tongue couldn't elevate properly hence palate wasn't
shaped normally.
My guess is this breech in your client's baby somehow prevented normal
palate formation (the ridge and the flat palate). There may also be muscle
tension preventing the baby from opening the jaws. PTsounds like a good
idea, but why not some OT as well? OTs are feeding specialists, and have
to
devise safe feeding plans for all sorts of compromised infants. The last
baby with breech and torticollis I worked with was able to partially bfeed
after a regimen that included:
OT and PT therapy
Long term pumping to protect milk supply
Use of increasingly wider based bottle teats (I moved baby from
narrow teat to Avent to help baby learn to flange the lips)
Transition to breast with nipple shield in seated straddle position
Gradual weaning off shield
If your baby won't tolerate penetration into the oral chamber it may be
that
there is an overactive gag or some other issue like sensory defensiveness.
The OT can devise a sched. of graduated exercises that help baby accept
increasingly deeper oral penetration. I worked with an OT with a baby with
extreme sensory defensiveness and we used pacifiers of graduating lengths
and played gentle stroking games with baby to help him accept more depth.
This baby had been intubated for a month due to infected cyst in the lungs
and was very aversive to anything going in the mouth to the extent that at
6
wks pp when I saw him he was being gavaged all night just to get enough
milk
in him to keep him alive.
Luckily this baby of yours won't die, and the best case scenario may be
human milk feeds delivered some other way that keeps options open.
Personally, I'd work on getting the baby to be able to accept objects in
the
mouth.
Hope this helps,
Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com
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