I just read a fascinating study:  V Abadie, A Andre, A Zaouche et al: Early
feeding resistance:  A possible consequence of neonatal oro-oesophageal
dyskinesia, Acta Paediatr 2001; 90:738-45.

A group of French researchers looked at early feeding disorders that seemed
to have no clear organic basis, yet resulted in very early poor feeding,
feeding resistance, and decreasing weight gains.  The babies all were worked
up in hospt. for FTT with manometry studies (to examin esophageal function).
A swallowing disorder (similar to but distinct from gastro esophageal
reflux) was identified.  The babies were generally not able to breastfeed,
and bottle feeding was marked by feeding refusal, long, difficult feeds,
excessive crying, regurgitation.  More than half of the babies had mild
anatomic facial consequences of poor neonatoal sucking (i.e. receding chins,
arched palates, mild hypotonia of the tongue) but were otherwise clinically
normal and neurologically fine.

The researchers observed that since the esophagus is inverated by the same
brainstem structures that control sucking and swallowing, poor
oro-esophageal motor control can result in inability to feed/swallow
normally, creating risks of aspiration that cause children to self-limit
intake.  This appears to be a transient disorder, and typically improves as
masticatory feeding replaces liquid feeds.

What does all this mean to the LC or (esp) the Leader, who may not see many
abnormal babies.  Well, it means that good wishes will not fix all problems
because sometimes there is something wrong with the baby.  These rather
subtle disorders (and this one prob. effects maybe 3% of babies) support the
idea that when a baby can't or won't feed, it is a sign of a disorder.  Can
the baby with dysphagia nurse safely?  Maybe, maybe not. Will solids help --
they seem to in other similar disorders.  I think that the idea of chilling
the milk to solid consistency provides a way to get the milk into the baby.
I think a very soft breast is a way to satisfy sucking, and a nipple shield
may help to block overwhelming sprays of letdown.


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

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