Dear Nikki and everyone else,
Catherine is right on target. Babies do want to breathe before they want to
eat. If this baby is coming off, a little blow by might help, or that just
might be the way it is until he feels better. He is just trying to pace
himself. If her milk is in, she should pump some off so he'll be able to handle
the flow more easily. The reason that he has no problem with a pacifier and
has to pace himself with the breast is due to milk flow. Ten pound babies
who have RDS make me think of babies of diabetic mothers, who tend to act 2-4
weeks less mature than their gestational age. Could this be a factor? He
may be more immature than we think, and along with the lung disease, he has
good reason to have to pace himself with feedings.
Thank God he didn't have a free-flowing bottle. Making him eat by screwing
in a bottle would be very, very bad!
In our NICU, we'd let this baby breastfeed ad lib with an IV in, unless we
really thought he was preterm. We probably wouldn't go for the gavage tube
for a neurologically normal term baby. If he were in that much distress that
he didn't want to eat, putting in a gavage tube and force-feeding him would
only stress him further. His respiratory distress, if it's from pneumonia,
should resolve in a few days. And this baby would have lots of opportunity to
learn to breastfeed.
I think Paula Meier's work could apply here. Her work shows
cardiorespiratory stability with premies who breastfeed, and not bottlefeed. It has to do
with flow and pacing breathing with suck and swallow. There was also a study
done with cardiac babies at Children's Hospital in Boston--one of the authors
was Kim Barbas. I believe that they found that these babies tolerated
breastfeeding very well. I think both of these studies show that babies who are
"compromised" tolerate breastfeeding with better cardiopulmonary stability. I
think you could easily add in babies with pneumonia. If sick babies are too
sick to breastfeed, they don't even bother trying.
I have been present while many sick babies have gone to breast. If they are
starting to desat, they pull off and breathe fast to compensate. If they
don't feel up to going back to breast, they don't.
Maureen Allen RN, BSN, IBCLC
Lactation Consultant, NICU
Brigham and Women's Hospital
Boston, MA
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