It has to do with several things related to oral motor 
function...preterm infants studied in US NICUs use less negative 
pressure in sucking. Donna Ramsay's newest research showed clearly that 
negative pressure (caused by the downward deflection of the posterior 
tongue, resisted by the cheeks and lips) pulls milk from the breast, 
contrary to our current beliefs that positive pressure was more 
important in milk removal during bf. Also, as infants mature, their 
improved coordination of oral motor movements increase the amount of 
milk they can consume at breast per unit time. (see studies by Lau and 
Schanler). Preterm infants are at a disadvantage particularly if they 
are not able to get the practice they need to improve their coordination 
on the breast, and due to their reduced use of negative pressure (and 
reduced cheek stability due to the immature or absent buccal fat pad, 
etc) and reduced tone, etc. The "take home" message is that preterm 
infants are at a disadvantage for feeding, due to many factors that I 
mentioned in my previous post on bottles and premies. Some preterm 
infants are able to compensate, especially with additional maternal 
assistance - postural support, skin to skin, frequent short feedings. 
Some are not and require extra food in the easiest possible way. The 
more rigid the NICU environment (forbidding skin to skin or holding, 
requiring 3 hourly feeding, etc) the less likely that the mom and baby 
will be able to compensate for the preterm infant's built-in feeding 
challenges. Part of our job as LCs is to help mom come up with the 
compensatory strategies that will help her infant, so she does not have 
to reinvent the wheel, but also to recognize when all the breastfeeding 
strategies in the world are not going to be enough and help with 
alternate feeding as well.
Catherine Watson Genna, IBCLC  NYC

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