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Date: | Thu, 13 Oct 2005 11:11:37 -0400 |
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It has to do with several things related to oral motor
function...preterm infants studied in US NICUs use less negative
pressure in sucking. Donna Ramsay's newest research showed clearly that
negative pressure (caused by the downward deflection of the posterior
tongue, resisted by the cheeks and lips) pulls milk from the breast,
contrary to our current beliefs that positive pressure was more
important in milk removal during bf. Also, as infants mature, their
improved coordination of oral motor movements increase the amount of
milk they can consume at breast per unit time. (see studies by Lau and
Schanler). Preterm infants are at a disadvantage particularly if they
are not able to get the practice they need to improve their coordination
on the breast, and due to their reduced use of negative pressure (and
reduced cheek stability due to the immature or absent buccal fat pad,
etc) and reduced tone, etc. The "take home" message is that preterm
infants are at a disadvantage for feeding, due to many factors that I
mentioned in my previous post on bottles and premies. Some preterm
infants are able to compensate, especially with additional maternal
assistance - postural support, skin to skin, frequent short feedings.
Some are not and require extra food in the easiest possible way. The
more rigid the NICU environment (forbidding skin to skin or holding,
requiring 3 hourly feeding, etc) the less likely that the mom and baby
will be able to compensate for the preterm infant's built-in feeding
challenges. Part of our job as LCs is to help mom come up with the
compensatory strategies that will help her infant, so she does not have
to reinvent the wheel, but also to recognize when all the breastfeeding
strategies in the world are not going to be enough and help with
alternate feeding as well.
Catherine Watson Genna, IBCLC NYC
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