Those of you who work in NICU must already know this, but as a "still learning" IBCLC <grin>, I started looking up Side Lying Bottle Feeding - first in my Wolf and Glass (Yes, I still have my original one with their autographs), where they mention: "This may help a retracted tongue come forward.  The feeder must be observant so that the head does not move into excess extension."

I then found this study: 
 Park J1, Thoyre S, Knafl GJ, Hodges EA, Nix WB.  Efficacy of semielevated side-lying positioning during bottle-feeding of very preterm infants: a pilot study. J Perinat Neonatal Nurs. 2014 Jan-Mar;28(1):69-79. They state: " The findings indicate that the ESL (Semielevated Side Lying) position may support better regulation of breathing during feeding, thereby allowing VP (Very Premature) infants to better maintain physiological stability throughout feeding."

And then I found this very informative YouTube: https://www.youtube.com/watch?v=5e1KBtjYYns 

I would like to hear from those of you who are experts working with Very Prematures what you think of it.  

Some of the information, of course, is for the Very Premature and I am unlikely to use, but the rationale for their instructions I think I will find very helpful for either bottle feeding babies who have separation, have feeding difficulties at the breast, or physical problems beyond prematurity.  

One caution I heard over and over - that the baby not extend the head - has me asking a question:  Perhaps they are concerned about babies who are hypertonic, but with full-term breastfeeding babies, I see that some moms hold their babies at the breast with their chins deeply into their own (not their mother's chest) chest.  This often causes nipple pain, but if moms move the baby towards their diaper or their feet, (and the baby is going "uphill" as you see in many breast crawl videos), they can more completely open their mouths to grasp a larger amount of breast.  The head may then be tilted back more than is recommended in the videos I've seen.  

Of course breastfeeding is different from bottle feeding, but at the same time, I have babies who can't handle mom's fast flow or have reflux - these babies usually benefit from position changes similar to bottle feeding babies (side lying or baby on top), so I'm trying to see how this information could apply to my own observations and recommendations. 

Thoughts?

Jeanette Panchula, BSW, RN, PHN, IBCLC
Vacaville, CA

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