When babies have this much difficulty feeding, there are several things
to look for:
- cardiorespiratory issues - baby will use short sucking bursts (3-5
sucks), long respiratory pauses, and may have noisy breathing or panting
in those pauses. Babies with collapsing airways may have stridor during
breathing (a high pitched, squeaky sound). Managing flow helps these
babies. Head extension and a prone position for feeding helps if it's
respiratory.
- swallowing difficulties - baby will have stridor during the tail end
of swallows, or will sound gulpy, hold the breath when swallowing,
and/or breathing begins to sound wetter and harsher as the feeding
progresses. These kids are aspirating. Again, pacing and prone
positioning help. Cervical auscultation is a good tool for listening to
baby's swallowing, just use a stethescope (a neonatal head is ideal, but
a cheap adult one works too) under baby's chin and listen. Swallowing
should sound like a crisp, biphasic sound (glug-ug). If there's
bubbling, whistling, rattling, stridor, or a delay in getting milk out
of the airway, you'll hear it with a little practice. You can also hear
the coordination of swallowing and breathing. We want babies to swallow
in breathing pauses, and breathe in between swallows.
- neurological/genetic issues - there are many syndromes that cause
feeding problems. Any baby who has problems feeding deserves a good
examination by physicians as well as therapists. A genetics workup is
helpful for infants with feeding problems, especially if they have low
muscle tone and slow growth as well. There are a few syndromes that
cause the baby to be large at birth and grow very poorly afterward. What
one does to support the feeding depends on the baby's specific difficulties.
If you have a more detailed assessment to share (even of the bottle
feeding) I'd be happy to offer more suggestions.
Catherine Watson Genna, IBCLC NYC
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