Generally if babies are willing to breastfeed with an elevated
respiratory rate, they are able to. This was the ideal feeding situation
for this little guy - he was able to self attach and remove himself as
his respiratory capacity dictated. He may not be able to get enough milk
with his reduced aerobic capacity, but he should be allowed to
breastfeed if he is initiating it! Babies do not choose feeding over
breathing, and will refuse to feed if they do not have the ability to
sustain the work of breathing *and* feeding. Letting a baby who has a
respiratory problem feed in short bursts ad lib is ideal! If he can't
get enough on his own steam, he can be gavage fed the rest of his
requirement, but he might surprise everyone if left to his own devices
on mom's chest.
That said, there truly is a difference in sucking a pacifier vs a breast
for infants with respiratory issues - and that is flow. Swallowing needs
to be coordinated with breathing, and when the flow rate is high or the
respiratory rate is rapid, swallowing reduces the amount of time devoted
to breathing. For an infant with an increased baseline respiratory rate,
this can mean that he is not able to get enough oxygen. Allowing the
baby to determine when to come off the breast or stop sucking to take a
breathing break is the obvious solution, coupled with careful tracking
of his intake until he shows he can "do it". The same issue exists with
preterm infants. Their respiratory capacity is often immature, and they
need frequent respiratory breaks during feeding. I wish I videotaped a
recent consult with a 33 weeker on an apnea monitor. She had been taking
bottles of ebm and mom had a wonderful supply, but mom was unable to
help her breastfeed (mostly because she was using too small a nipple
shield, and not drawing the breast into the shield). We changed to a
shield that would accomodate mom's nipple, gave baby postural stability
against mom's trunk, and she lunged for the teat and took 60ccs, the
best she has ever done on a bottle. Whenever her breathing got a little
noisy and rapid, she stopped sucking, and as soon as it normalized, she
started again. Mom had been taught to prod her to try to keep her
feeding (which of course would destabilize her), but very quickly
learned to just leave her alone and let her selfregulate.
Baby did great, monitor did not go off, everyone happy. Too bad the
little guy Nikki saw is not going to have that opportunity until he gets
out of the clutches of the nurse who won't learn from research.
No flames about the nipple shield, please. This baby was so hypotonic
and low energy that she really needed to not have to work to keep the
breast in her mouth.
Catherine Watson Genna, IBCLC NYC
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