Catherine I was posting while you were posting so I didn't see it ;-)




> Sounds like this baby is using all negative pressure to bottle feed -
> drawing in the cheeks - and no positive pressure. (you said the baby was
> full term and has normal buccal fat pads, no?)

*Yes* that is what i am saying. Term. Not the fattest buccal pads i've seen
but let me have a better look again tomorrow

>  If the tongue does not move during sucking, the baby might not be able
> to move milk from the Haberman.  One advantage of using the Haberman is
> that compression works better than suction, and it could help encourage
> the baby to try to use the tongue, especially if the jaw were stabilized
> with a Dancer Hand position to help isolate tongue movements.  One can
> do this with bottles by using the thumb and first finger on the baby's
> cheeks, the jaw in the webbing between the thumb and finger, and the
> bottle resting on the palm of the hand.  Takes a tiny bit of practice,
> but works well.  The other way to do this is to hold the bottle in the
> webbing between thumb and finger, and bend the middle finger 90 degrees,
> and place it under the baby's chin.  The second method is usually more
> comfortable, for me at least.

I did show her Dancer hand yesterday even though he wasnt interested in
breastfeeding. Will review tomorrow.
>
> I'm not saying that the mom should be nagged to use a Haberman if she is
> uncomfortable with it, just sharing the clinical judgements I'd weigh
> out for this baby were he my client.  Another possibility is a pigeon
> (Japanese brand) cleft palate nipple.  It fits on standard bottles (are
> Australian standard bottles the same as American standard bottles?)
> using standard rings.  That might be more cost effective.  It only
> requires slight tongue elevation to spray milk out of this nipple.

I think the mum is happy with the Avent and he seems to do OK with it so we
will see how it goes. Will keep your suggestions handy.
>
> If the tongue is short (which often is the case when the lower jaw is
> small) bring the jaw into the mom's breast by extending the baby's head
> (sometimes rather strongly, since their soft palate and epiglottis are
> in closer contact than an adult's they can still swallow in this
> position) at breast.  Sidelying usually produces the strongest
> extension, especially if the baby's lips are placed south of the nipple
> so he extends the head and opens wide, and as soon as his upper lip
> clears the nipple, baby is snuggled close by mom's hand at the center of
> his back (mid-thoracic area).

Yes i discussed this yesterday too, but dont know how much she was taking in
so will go over it again tomorrow (she is probably a bit shell shocked with
all this, i would imagine! All this information in a short length of time.)

Thanks again Catherine you have been a great help!

Karen Clements

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