I have no real knowledge about goat's milk, etc. and not a whole lot
about adoptive nursing. But I have seen enough problems at WIC to mention
the importance of emphasizing a SLOW rate of feeding, with pauses between
pulses. This is helpful in sorting out whether it is the liquid being
fed, or perhaps the manner in which it is being fed that is causing
problems.
1) the preformed nipple with one hole often squirts milk straight to the
back of the throat, stimulating gag reflex and/or competing for space at
the back of the nasopharynx, interrupting the path of air from nose to
larynx.
2) this is especially true if the baby has a strong sucking reflex.
3) if liquid has been warmed, this makes the flow faster and more
forceful.
4) babies responding to this often appear to be "chuggalugging" it down,
which is misinterpreted by adults as proof of their hunger or
"greedinness".
5) it is in fact a stress reaction caused by fear of choking, and
resultant inability to coordinate breathing, sucking and swallowing
without anxiety.
6) it ends up a viscious cycle because the baby's coping effort often
manipulates the rubber nipple more frantically, increasing the force and
flow rate.
7) poorly coordinated suck/breathe/swallow has even been shown by
electronic monitoring to slow the heart rate, at least in prematures.
8) this whole process can result in overfilling the stomach, long before
the 20 minutes that the first few cc.'s need to complete the digestive
process, be absorbed, change the blood glucose level and deliver that
signal to the satiety center in the brain.
9) This seems to bear a certain resemblance to the cycle triggered by
severe OALD (overactive let-down).
I have had success in explaining this slower "pulse/pause" method to
parents, cautioning them to keep the baby as upright as possible, let
them have a maximum of 4-6 sucks, tilt the bottle down so the nipple is
empty while allowing the baby to catch his breath and relax his fists and
breathing efforts, and repeat this several times, while calmly reassuring
the baby "We won't let you starve, or choke etc. etc." Saying these words
reassures the adults at the same time as the tone of voice reassures the
baby.
I recommend that they take frequent "burping, cooing and rocking" breaks,
after the initial "pulse/pause/pulse/pause" sequences, dawdling long
enough that only 1-2 ounces or less has been fed by 15-20 minutes. The
satiety feeling (not due to volume consumed but blood sugar changes) will
take over and the baby will usually slow down and stop on his own, at a
much smaller volume than when consuming it rapidly.
I suspect this imitation of "MER, trickle, MER, trickle" rate, also helps
to reduce the danger of "nipple confusion", which I am now convinced is
at least 50% flow rate confusion. Some parents (and professionals) simply
cannot or will not cope with alternate feeding methods when the baby is
not feeding adequately from the breast. If the bottle simplifies their
life, they may at least be open to adjusting the flow rate of any
necessary supplements.
If this is too elementary, I apologize, but I have seen it happen so
often to parents, grandparents, babysitters, etc. who have the best of
intentions, I thought it worth mentioning.
Jean
**************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA
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