I was delighted to see Dani's post about using the work of H. Als to teach
recognition of infant stress signs in the NICU.  She states that this helps
prevent feeding problems.  I agree, and think her work is so important.  I
think all LCs should read this work so they have a better grasp at the
developmental level and can identify motoric stress signals.

There was recently a thread about swaddling to prevent arm flailing.  This
is a motoric stress signal.  While swaddling can help provide physical
containment for the tonic, disorganized infant by providing firm
proprioceptive and deep pressure contact, we must keep in mind that the
infant is acting this way for a reason.  If we don't look a bit deeper to
try to identify the cause of the stress, we may inadvertently make feeding
more stressful with our interventions.  This necessitates a lot of close
detective work, because a lot of motoric stress cues mimic neuromotor
abnormalities.

  For instance, arching and hypertonicity can be a sign of a neurological
problem.  It can also be a motoric stress signal from a baby who has (among
other possibilities) a problem handling a rapid flow rate during let-down,
especially if positioned with too much flexion at the neck.  I really liked
Ros's decription of Chole Fisher's new swaddling idea which positions the
arms at the infant's sides.  I would think that would minimize the risk that
baby would be swaddled in a too-flexed position.

Some of the reasons for development of hypersensitive and aversive responses
to tactile stimulation include:  immaturity, chronic illness, unpleasant
oral-tactile experiences, neurologic impairment.

Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html