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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