Erika writes:

What do  you ladies know about dysphagia? I have a client who recently had 
her 8 month  old diagnosised with this and the children's hospital told her 
that she  shouldn't use breastmilk but instead use formula and thicken it. I 
have never  even heard of dysphagia so I thought I would see if there is 
anyone with any  information on this? 
 
~~~ I'm sure there are experts who know more than I on this list, but just  
to get us started: dysphagia just means having difficulty swallowing. Some  
babies who have dysphagia actually have an undiagnosed tongue tie, but 
others  have no structural/anatomical reason for this difficulty and it may be 
more  related to having low tone or something else. Babies can develop this 
after too  much refluxing, or they can have it inherently for reasons we 
sometimes can't  figure out or that become evident later. I've seen some babies 
whose dysphagia  doesn't become evident until they reach the life stage when 
they begin  complementary feeding, and have to cope with solids. They may 
fall off their  growth arc then, or show other issues. You are right that 
mother's milk is  usually easier to coordinate in terms of SuckSwallowBreathe, 
easier than AIM a  study showed. But there are some babies who have such an 
issue they cannot  safely swallow even their moms own milk. Some things 
suggested as thickeners  don't really work with human milk because the 
properties in the milk begin to  digest it and it thins out anyway. There are also 
things like Thick-It which is  made as a food additive for those people who 
really cannot swallow any  liquid safely.  ( Like my grandmother when she was 
in her 90s, or someone  after a stroke. This is used for very challenged 
babies too sometimes.) One  major challenge I've found is that many feeding 
therapists ( OTs and SLTs,/SLPs)  use bottlefeeding as the norm and only know 
how to work off that. They may think  breastfeeding is part of the issue, and 
it often is not. ( In rare cases, as I  said, nothing can really be safely 
swallowed without aspirating.) When I can, I  try to attend at least one 
session with the OT/SLT/SLP with the mom and baby to  see what their point of 
view is and whether they actually know anything about  normal (meaning 
breast-) feeding. 
 
Hope that helps and someone wiser jumps in with more info.
Peace,
Judy  

Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
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