I really appreciated Katherine West's review of the lecture she heard about
sucking ability in preemies.  I think that it adds to our understanding of
how complicated these early feeding issues are and how vital it is to
individuate care.  We limit our ability to "see" the individual we are
working with when we get stuck in dogmatic beliefs that because one baby did
this, therefore all babies can do that.

On the same subject, I just read an interesting paper:

 M Hafstrom, I Kjellmer:  Non-Nutitive Sucking in the Healthy Pre-term
Infant, Early Hum Dev 2000, 60:13-24.

The authors describe sucking behavior as one of the first coordinated
muscular activities, and that it is controlled by the brainstem (therefore
is dependent upon maturation).

The authors talk about suck appearing in two different modes, nutritive suck
(NS)  and non-nutritive suck (NNS).  NS is almost continuous, while NNS is
organized as a series of bursts speparated by brief pauses.  They speculated
that there are two different central organizations for sucking behavior.
NNS is primarily dependent on maturation and is little affected by
post-natal age or feeding experience.  They observed that post-menstrual age
was the dominant predictor of non-nutritive sucking activity (NNS) but
gender, state of activity, and weight also influenced it.

NNS is thought to lessen distress, decrease crying during painful activities
and improve behavioral state. Accelerated maturation of sucking reflex and
earlier readiness for feeding is reported when preemis are given NNS
opportunities during gavage feeds.  Also NNS improves gastric motor function
and facilitates digestion.

I hope the authors will go back and use the same sophisticated methods of
measuring suck to look at nutritive sucking. I think it is clear that some
fluid is transfered from breast to baby in NNS, and as Katherine points out,
the more stable preemies may transfer milk.  However, they still may need
assistance until maturation kicks in with stable sucking activity, and they
will def. need more help if impaired by illness or stress.

Ability to feed should be seen by all assessors as an important indicator of
viability (right up there with breathing!)  If an infant can't sustain
stable sucking, swallowing, and breathing, the kid is in trouble.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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