Colette writes:
-a referral to early intervention has been made to investigate possible
suck or sensory issues and an appointment has been made for another
craniosacral treatment.
I and my IBCLC colleague are at a loss here...not sure what is going on
and why this baby isn't gaining weight more, fussiness, etc.
Any words of wisdom would be appreciated.
~~~
Collete and all,
No wisdom here, just a few observations/thoughts. First, more CST and EI
eval sound like good plans. I try to be there during the EI visit both to
learn and to share what I have seen with a baby. I also often, but not always,
go to the CST visit. This may not be possible for all practitioners, but I
try to make it work. I guess posterior tongue tie and laryngomalacia ( and
possibly submucosal cleft) are not part of the picture or it would have
been mentioned. They can both, especially together, result in the kind of
scenario you are describing. If this baby isn't gaining in a way that seems
healthy, I would describe a baby that is crying or fussing between 2 and 8 as
"hungry and frustrated" rather than "fussy." It may be that baby is more
fatigued/less organized at some times of day related to their own issues and
the ebb and flow of milk production/release over the day and night. One
cheap intervention is to do Kangaroo Mother Care, or true skin to skin as
much as possible. This helps with both milk supply and homeostasis so baby has
more energy directed toward growth and development. Hopefully baby is
sleeping in sensory awareness to mom as well. Sadly, I've seen babies that are
so hungry, but too fatigued/disorganized to eat, and of course they fuss
and cry if they are remotely healthy. (When they stop even trying to signal
their needs we are in real trouble. ) If baby does have some muscle or body
asymmetry that CST or OT/PT/SLT can help with, that would be good. Feeding
is a symmetric activity and when the body is out of symmetry, I think it
has to work harder, and it costs more energy to do the task. Sometimes babies
with "normal range intake" ( like 110 in a feeding is in range, but this
baby may then decompensate and transfer little for the next feedings....)
for most or even all of the day, still may not gain because they need more
than the normal amount of energy, their bodies are working so hard. I've also
seen babies whose reflux is so bad, they actually are giving back most of
what they've worked so hard to get down. This is not seen unless one
measures by scale, because some babies seem to be spitting up a lot and have lost
a few tenths, whereas another baby I worked with got 3 ounces down and 2.5
came back! Does any of that make sense? Anyway, the bottom line is this
family is lucky to be working with you.
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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