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Fri, 11 May 2007 08:38:07 -0400 |
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I agree with Laurie that this baby should just get fed in the most
pleasant way possible, and given lots of skin to skin and TLC so he can
recover from the intrusions of NICU life. And that mom really needs a
hospital grade (metal piston) pump. The suction curves are smoothest for
these metal piston pumps, and that's most likely to be most helpful for
her right now.
I would also help her to make the baby in charge of anything entering
his mouth. Mom can just gently touch the bottle nipple across his lips
(with the top of the nipple touching his philtrum, the ridge between
nose and mouth) until he opens up wide. This is also good practice for
the wide gape one needs at breast. Then she can tip the bottle into his
mouth. She can hold baby sidelying for bottle feeding, right near her
bare breast, so he gets used to being there for food.
Is this baby truly hypertonic (muscles so tight it's hard for him to
release them for use) or is he arching in frustration or from stress?
There is a difference, and the "treatment" is different. If the baby is
showing arching behavior when placed at breast because he doesn't know
what to do there or is pursing his lips to say "keep out of my mouth",
that's a functional communicative behavior and is very different from
having a neurological injury that causes the brain to overactivate and
stiffen the muscles. If the baby is really hypertonic, he needs physical
therapy to help with positioning to help change the maladaptive muscle
use patterns and support his brain's recovery to the degree possible.
There are some preparatory handling techniques that could help in either
case, such as swinging him gently in arms or in a blanket from head to
food (through the spine) until his flexion increases. Hip flexion
(having his legs bent around mom's side) can decrease arching behaviors
and help interrupt hypertonic patterns, but you can't just force him
into flexion.
Catherine Watson Genna, IBCLC NYC
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