Angie,
I have a friend who is a chiro/CST who has immense expertise with feeding issues. She and I have discussed with Dr. Coryllos in the past year that we have noticed lots of kids with "feeding issues" have tongue-ties.
Often these kids have serious neurological or other difficulties that are associated with feeding problems. We surmise that no one looks for TT b/c it is accepted that feeding problems are common for these kids. But, how might feeding be optimized if TT was addressed? We have also worked together to treat kids who were diagnosed with reflux and tracheomalasia whose symptoms seemed to disappear in short order when TT and/or structural work was addressed. I urge anyone working with kids with feeding problems not to overlook these very important aspects of care. I work with a PT who does Integrated Manual Therapy who works extensively with disabled kids--his approach is always that when you take the stress off the system, you optimize potential. I referred a baby to him years ago whose mom was told by a neurologist that he would be blind, never walk, never talk--a dire prediction indeed. I did not buy it, nor did she. He does all of those things now, and while he contends with delays and other obstacles, he has a quality of life that would never have been possible had mom stayed within the mainstream medical system. I always assume that all things are possible and work from there. 



Date:    Wed, 25 Jun 2008 09:34:32 -0400
From:    "Kirkwood, Angela" <[log in to unmask]>
Subject: thickeners

In our facilty we use rice or oatmeal infant cereals for infants under
one yr of age.  Sometimes for toddlers as well, but other foods can be
used as they become older and better skilled.  Please remember that when
cereal is added, it is a medical treatment, not a means of making
feedings convenient for parents.  I know that in our facility, we do not
have any docs or specialties that would recommend so without there being
a clear medical benefit-keeping in mind the AAP standards.  If an infant
or child required thickening for airway protection and/or
gastrointestinal and refluxing problems, it is a medical treatment.
Using a rice or oatmeal infant cereal will provide calories that have
some nutritional value, where the commercial thickeners that are used
for adults are corn/carbohydrate based.  Remember that when the liquids
or pureed foods are thickened, there will be less volume taken in.  This
is why we choose to use the infant cereals.  An older baby can have
their foods mashed to the approptriate nectar, honey or pudding
consistency.  The idea about the slush is not adaptable in these
situations because as it would warm in the mouth or esophagus, it would
again become thin liquid.  I prefer to TRY thickening breastmilk in
these situations.  Sometimes it will work but in the most severe and
dangerous airway/aspiration risks, it does not.  Yes, you can add pumped
breastmilk to other solid foods.  You can also use yogurt to thicken.  I
also encourage parents to make their own baby foods, that way they can
mash or puree to the right consistency that their baby needs.  A
modified barium swallow study OR Fiberoptic Esophageal Swallow Study wil
be able to show what the appropriate texture needs to be if it airway,
pacing issues.  If it is reflux related, it is just trial and error.  I
would never recommend using a gelatin for an infant.  Probably not a
toddler either since they probably have other feeding and nutrition
issues as well.  Transitioning from GT feeds to oral feeds is a very
long and difficult process usually.  There are behavioral as well as
functioning issues.  If you look at the speech pathology type of texts,
there are windows of opportunity for oral feeding and transitioning of
skills.  We are in the process of building an outpt feeding team
consisting of multidisciplinary members:  myself RN and IBCLC, OT,
Speech.  Is there OT and or behavioral specialists involved?

Angie Kirkwood RN, BSN, IBCLC

Nurse Feeding Specialist and Certified Lactation Consultant
Children's Hospital of Pittsburgh


 


 


Jennifer Tow, IBCLC, CT, USA
Intuitive Parenting Network LLC

 


 




             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome