I just read an interesting article.  It's too lengthy to copy and send, so
please, if you are interested in the full text, go to the med. library and
copy on your own.  I will share some main points.

Ramsay,M and Gisel,E:  Neonatal Sucking and Maternal Feeding Practices,
Developmental Medicine and Child Neurology, 1996, 38:34-47.

The authors devised a non-invasive way to measure sucking strength (a
pressure sensor
instrument taped under the infant's chin that records and measures sucking
movements without interfering with the feeding mode -- breast or bottle).
They measured suck, sucking bursts, burst durations, and longest sucking
bursts.  Mothers were also admin. a questionaire that avoided asking leading
questions (i.e. if the
baby had feeding problems, but focused instead on feeding-related questions
that teased out that information).  Reliability of the tools was
well-established, and responses were scored by two teams and then compared.

Infants who were identified as having feeding difficulties differed
significantly from those who were not:  They had shorter continuous sucking
bursts and shorter sucking times than infants in the non-compensatory group
(i.e. the one's whose mothers, responding to infant cues, either nursed
longer, supplemented more, or used other compensatory methods to assist the
infants).  Thus, infants who later showed some feeding difficulties were
already exhibiting poorer feeding ability shortly after birth.  "This study
supports the validity of maternal perception about their infants' feeding
ability....optimal sucking performance appears by the third day.  These
results indicate that there is stability in sucking behavior among neonates,
and that their sucking behaviors are more similar from test to test the
older they become."

"...a study demonstrating an association between early and later behaviors
of
sucking in healthy neonates would not only imply that neonatal sucking is a
good indicator of later feeding ability, but may add to the elucidation of
the etiology of what is currently known as non-organic FTT...This
preliminary study has two aims.  The first was to demonstrate the stability
of sucking patterns in healthy infants accross their first six weeks of
life.  The second was to discover whether ther was an association between
neonatal sucking patterns and clinical feeding parameters at six weeks of
age".

Some of the clinical implications are interesting to me -- esp. the
importance of paying attention to dyads who are struggling with feeding
early on.  This is a red flag.  Some of the
mothers who switched to bottle feeding blamed lack of time to breastfeed for
the reason, but the researchers identified that one common compensation for
the poorly breastfeeding baby's mother was for her to feed more often and
for longer.  So ,  "...while the mother blamed lack of time for changing to
bottle-feeding, it may well be that her infant's poor sucking ability
influenced her decision...Infants whose mothers changed feeding practices
with the first six weeks had shorter sucking bursts and spent less time
sucking during the first test at two to three days than infants whose
mothers did not change feeding practices.  This suggests that the former
infants were sucking less efficiently form birth."

The authors warned that early weight gain wasn't a reliable measuremt of
early feeding ability
because mothers were so adept at compensating.  Therefore clinicans should
be "wary about interpreting good weight gain in an infant as an index of
good feeding ability without having asked the mother about her feeding
practices..."  Intrinsic feeding ability needs to be considered, and this
shows up EARLY.

Therefore, we need to listen to moms who say:  My baby isn't feeding well.
And, we need to be aware that the normal pattern of early feeding is that it
should look stable and work well from about Day 3 on.  Babies may be
temporarily affected by epidurals or
birth trauma, but it isn't normal not to be able to feed well, and the moms
who are working really hard supplying lots of compensatory help need
assistance because they are likely to abandon the effort due to negative
feedback from the infant whose hunger cues are not assuaged by the current
feeding method.


Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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