Hello all,
Laura asks:
Also, the therapist told mom that baby needs to tuck her chin when
feeding, the exact opposite I suggested. Which is correct?
~~~
Hi Laura and all,
This is the common perspective of OTs/SLTs who were educated in a
"bottlefeeding as normal culture" meaning all of them in the US, and probably many
other places too. Chin tuck is believed to help prevent aspiration. You are
right, that light neck extension is the current standard for positioning
for effective, comfortable, and normal/ 'safer' breastfeeding. Articles by
Pediatric RNs, OTs and SLTs will say the opposite.
_http://www.medscape.com/viewarticle/475183_4_ (http://www.medscape.com/viewarticle/475183_4) is an
example:
"Safety and efficiency are enhanced with upright positioning and the use
of a chin tuck head posture, which allows food moving from the mouth through
the pharynx into the esophagus to be directed away from the airway. This
position also provides greater stability of the mandible for improved
suck/swallow in the infant. "
Feeding specialists who are not LLLLs, IBCLCs, other
breastfeeding-as-norm and breastfeeding knowledgeable people, view infant feeding in terms of
the skills, positioning, and modifications learned over time to help make
bottlefeeding safer, especially for infants with tone or other neuromuscular
issues. They know bottlefeeding can be risky for some babies. ( We know it
has risks/challenges for all babies, even those without neurological
issues.) There are many assumptions, even valid clinical experiences/truths,
about bottlefeeding norms that do not apply, but are often applied to
breastfeeding. ( For example, a top Infant Oral Motor Specialist told a client and
I that the expected norm for a 4 month old is "to be able to drink a 6 oz
bottle in 5 minutes.) Hopefully more and more IBCLCs will come from the
ranks of these helpful infant feeding specialists and as we work more as teams
we can learn what learning transfers, and is applicable, and what isn't. The
chin tuck may be something very important for babies being bottlefed
formula who have swallowing issues ( which many tongue tied babies do), but that
may not mean it's the best position for a baby at breast. Laid back
bottlefeeding isn't really possible,but laid back, or other modifications in
positioning might just be enough for a breastfeeding baby. I agree that we
cannot generalize how a breastfeeding baby does on a bottlefeeding swallowing
study, necessarily, to normal breastfeeding episodes. Glad mom has you for
support. Babies with normal tone but functionally restrictive tongue ties
must feel like runners wearing tight pencil skirts...
Peace,
Judy
Judy LeVan Fram, PT, IBCLC, LLLL
Brooklyn, NY, USA
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