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Subject:
From:
Barbara Wilson-Clay <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 10 Nov 1999 10:44:20 -0600
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Denise writes to share an interesting case of baby with multiple congenital
problems including soft-palate dysfunction, high arched palate, weak suck,
etc.  She states they are managing baby as they would a cleft palate case.
I think this is a good idea, however I would encourage the use of a Haberman
feeder rather than a squeeze bottle or syringe at breast for bolus feeds.
The soft palate is a muscle.  If it is weak, there tends to be fatigue after
even a short feeding episode.  The impact of this fatigue is that the palate
then tends to seal poorly against the raised posterior tongue, creating risk
of fatigue aspiration.  Bolused feeds can over-whelm the baby because the
feeder tends to bolus when the baby pauses for too long.  Those pauses may
be important rests or organizing periods for respiration.  Bolusing to get
the baby moving may result in micro-aspiration and create or contribute to
feeding aversion.  The Haberman is a better choice, because it allows more
infant control an d tends to inspire more infant trust.  I would guess this
child will be a real slow feeder.  Breastfeeding should be allowed and
encouraged because the work-out will exercise the oral structures.
Non-nutritive sucking, perhaps on a soft, gel-filled pacifier might also
help tone the oral musculature.
Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

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