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Date: | Fri, 25 Nov 2005 16:36:27 -0500 |
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These are the kids we lug those heavy scales around for! The loud,
uncoordinated swallowing sounds can be either tiny milk boluses or
saliva, and they show that the baby is not coordinating their swallow
correctly. This can either start with a tongue/sucking problem that
discombobulates ("scientific" term, that) the rest of the "cascade" of
movements that makes up the swallow, or a specific problem with the
pharyngeal part of the swallow. Usually when the baby makes loud gulping
sounds with a very tiny milk flow, the problem starts in the oral phase,
in my humble experience (In other words, no I don't have a reference for
this). Kids with pharyngeal phase problems usually have nasal
regurgitation, feeding induced apnea, or milk retained in the
hypopharynx.(look at articles by Lisa Newman). Those are the kids who
have wet breathing or nasal congestion after feeding.
You can get some idea of where the swallowing is messed up by listening
with a stethescope on the baby's neck, near the cricoid cartilage, or
under the chin if you can't get near the neck. Young babies will keep
right on eating and just ignore the stethescope. You'll hear either
bubbling of milk retained from an incomplete clearance of the
hypopharynx, stridor of laryngeal penetration (when the vocal folds
attempt to close rapidly while the baby is still trying to inspire), or
sloppy or slow or too fast movement of the muscles of the tongue and
pharynx when you really get a feel for it. You can learn more about this
by attending one of Robin Glass and Lynn Wolf's conferences on Feeding
and Swallowing Disorders in Infancy, or reading their book of the same
title.
Now, fixing the problem is a whole 'nother issue. Upright positioning or
more head extension or some preparatory tongue exercises might help.
Catherine Watson Genna, IBCLC NYC
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