The OT/PT/Speech Path literature decribes very eloquently the abnormal
sucking patterns babies develop when they are compensating for deficits in
some phase of the suck-swallow-breathe dynamic. If a baby has respiratory
compromise, for instance, the infant may hyperextend the head and neck
trying to maintain a patent airway. The baby may also try to keep the
posterior tongue somewhat elevated to protect the airway. These infants
often fatigue early in the feeding as a result of not being able to get in
enough breaths in-between swallows. They run out of steam, the result
being they mis-time dropping the soft palate and raising the back of the
tongue to seal off the oral chamber so they can snatch a breath. When the
palate and tongue don't properly seal, this leads to what is called "fatigue
aspiration." Babies who sniff milk up their noses each time they feed can
become
aversive and defensive. To get inside their mouth with any intention of
forcibly "training down their tongues" may undermine the one protection
against aspiration they have. This is just ONE example of what might be
going wrong when a baby manifests "sucking problems."
The people who developed suck training have speech therapy backgrounds and
really under oral motor physiology and anatomy. Advanced suck training for
LCs properly consists of workshops and reading material which broaden our
insights into the very intricate workings of the mechanics of feeding. The
compromised infant needs very sensitive support. I attend at least one
workshop each year which is specifically dedicated to this subject, and am
heading to one at Univ. of New Mex. in March. These trainings have helped
me enormously to see that the dysfuctionally feeding infant is just that:
dysfunctional. Our role is to identify the problem if we can, to think of
safe ways to make
feeding less stressful and to refer on if we can't, and to protect the
breastfeeding options. Many, if not most, of the infants that I identify
with dysfunctional suck need more maturation time, or to recover from a
physical problem, and would not be helped by what is commonly called "suck
training."
I applaud those who are hungry to find the magic solution which is promised
in terms like 'advanced' anything. There are no quick fixes, though. Wish
there were!
Barbara
Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html
Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html
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