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Date: | Sun, 3 Sep 2000 22:46:04 -0400 |
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Jeanette Panchula wrote:
>>>>baby was seen by MD (third), he said the fast respirations were normal,
not to worry, babies do this.
This is frequently said to parents to reassure them that babies do breath
faster than adults as a normal course but normal for babies is said to be
40 - 60 breaths per minute at rest (while awake) by many of the peds I works
with. One pediatrician I work with feels the average infant resting (again
while awake) respiratory rate is much higher than this and he is conducting
his own informal study to confirm this. Wolf and Glass's book "Feeding and
Swallowing Disorders in Infancy" gives a higher number, they say on pages
260/261 "resting respiratory rate (while awake) should not be above 70 to 75
breaths per minute prior to beginning a feeding session." They go on to say
"During a feeding session, if the respiratory rate goes beyond 80 to 85
beats per minute feeding should be stopped. If the respiratory rate lowers
after a brief rest, the feeding could be cautiously continued. If it
remains elevated, the feeding should be terminated."
I think there is at least a consensus that infants' respiratory rates seem
high to many parents although the actual rate considered normal has some
variation in my neck of the woods. I also think there is consensus that
parents need to be reassured of the normalcy of their infant's higher than
adult respiratory rate. However, having reassured multiple parents of this
normalcy a HCP may fail to appreciate when an even higher than normal rate
is reported, especially by a parent. The HCP may need to observe the
behavior to actually believe there is a problem.
In pushing for further evaluation I would make sure the behavior is
observed by ALL HCPs involved. Make sure it is a typical feeding session
they observe.
On the other hand, I would be interested if this behavior occurs if baby
nurses on a relatively empty breast (a not typical feeding session). Can
the baby suck, swallow, breath OK if the flow is slow?
It is possible that this baby is aspirating at some point in the
suck/swallow/breath or does not self pace to breath during that sequence.
This may be because of a too fast flow or it may be something innate in the
baby. You mentioned a tight frenulum (although mom doesn't have pain). If
the infant can't use his tongue properly due to the tight frenulum he may
not be able to form a safe bolus for swallowing and this may make him more
prone to aspiration.
Good luck and please keep us posted, Carla (in Maryland)
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