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Subject:
From:
"Catherine Watson Genna, IBCLC" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 18 Jun 2003 23:49:48 -0400
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text/plain
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Karen,
Sounds like this baby is using all negative pressure to bottle feed -
drawing in the cheeks - and no positive pressure. (you said the baby was
full term and has normal buccal fat pads, no?)
 If the tongue does not move during sucking, the baby might not be able
to move milk from the Haberman.  One advantage of using the Haberman is
that compression works better than suction, and it could help encourage
the baby to try to use the tongue, especially if the jaw were stabilized
with a Dancer Hand position to help isolate tongue movements.  One can
do this with bottles by using the thumb and first finger on the baby's
cheeks, the jaw in the webbing between the thumb and finger, and the
bottle resting on the palm of the hand.  Takes a tiny bit of practice,
but works well.  The other way to do this is to hold the bottle in the
webbing between thumb and finger, and bend the middle finger 90 degrees,
and place it under the baby's chin.  The second method is usually more
comfortable, for me at least.

I'm not saying that the mom should be nagged to use a Haberman if she is
uncomfortable with it, just sharing the clinical judgements I'd weigh
out for this baby were he my client.  Another possibility is a pigeon
(Japanese brand) cleft palate nipple.  It fits on standard bottles (are
Australian standard bottles the same as American standard bottles?)
using standard rings.  That might be more cost effective.  It only
requires slight tongue elevation to spray milk out of this nipple.

If the tongue is short (which often is the case when the lower jaw is
small) bring the jaw into the mom's breast by extending the baby's head
(sometimes rather strongly, since their soft palate and epiglottis are
in closer contact than an adult's they can still swallow in this
position) at breast.  Sidelying usually produces the strongest
extension, especially if the baby's lips are placed south of the nipple
so he extends the head and opens wide, and as soon as his upper lip
clears the nipple, baby is snuggled close by mom's hand at the center of
his back (mid-thoracic area).
Catherine Watson Genna, BS, IBCLC  NYC

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