Diane writes:

<What happens when a baby sucks for pleasure on an empty bottle after a
meal?
Does he swallow air?  If so, does it bother him, besides perhaps causing
a
larger burp?>

Interesting question. Even the most novice parents have heard that
sucking on an empty nipple/bottle "causes" air swallowing and are
oh-so-careful not to let it happen. I "debunk" this by informing them
it's mostly advertising hype, and assuring then that the throat of a baby
is actually designed for the simultaneous passage of both air and milk.
It's the speed and direction of the milk flow that may keep him from
coordinating his tongue and throat properly (can also happen with OAMER,
to keep this on topic). It gets their attention when I explain to them
how the choking sensation is more stressful to the baby (sometimes
slowing the heartbeat) than any accidental air swallowing.

So I myself wouldn't worry about an older baby experiencing a problem
from voluntarily continuing to "suck on an empty nipple for pleasure
after a feeding" . At least air doesn't "squirt" into or flood his throat
propelled by the force of gravity or vacuum, (or get forced up into his
middle ear) like milk often does when he is lying down far enough! It
seems as if any air sucked from the bottle would just become part of the
"pool" of air the baby was voluntarily moving through his naso-pharynx
during his breathing. And the sucking might keep him content until such
time as digestion might catch up and provide satiety sensations.

However, I imagine that a ravenously hungry baby might develop different
motions of his lips and tongue and soft palate by sucking frantically on
an empty bottle nipple. Done long enough and often enough, this might
have even a worse effect on his dental structures than the tongue motion
developed with a constant rapid flow.

Or just as bad, is when the parent tightens the collar enough to slow the
flow by preventing the reverse airflow back into the bottle, thus forcing
the baby to suck against the vacuum that will build up inside the bottle.
Another opportunity to talk up the natural, positive effects of
breastfeeding on development of the dental arch.

That "empty nipple" question has come up more since I've begun teaching
paced bottle feeding to parents who need to know, especially if I am
teaching it in person. (I demonstrated this technique recently by feeding
an ounce of EBM in front of a mother to show her how to help her frantic,
hungry baby re-organize himself. At the same time, another LC was
softening the mom's areola by teaching her RPS, then hand expression,. so
I felt we were empowering the mom in multiple ways. Then he was calm
enough and she was soft enough that latching took place easily.)

I made a point of having her listen to the baby's suck,
try-to-breathe-swallow pattern for the first 6-7 sucks, then pointed out
how relaxed (and relieved) the baby looked and his breathing sounded when
I leaned him forward and allowed the nipple to become empty for a moment.


I point out to them that when the airspace at the back of the throat is
below the constant flow of milk when the baby is lying too far down , the
milk "floods" (a very powerful word) the airspace and the baby has
difficulty trying to swallow and fit in a breath at the same time.

<Do any of you use a half-full teat (maybe with holes not even covered)
with
babies who need a slower flow?  Is the whole "sucking air" thing
mythology?
Truth?  Truth but it doesn't matter to the baby?

By not covering the holes with milk, do you find that the baby has to
suck
to drink, as opposed to swallowing in self-defense?>

Very thought provoking idea. (Can't very well suggest anti-gravity
positions for bottle feeding like we can in breastfeeding! Leaning the
baby forward and/or tipping the bottle back now and then so the bottle
nipple empties at least partially seems to be the next best thing.)

30-35 years ago I was "into" the orthodontic nipple hype, and I felt (and
maybe still feel) that one good thing is that the hole is not on the tip
of the nipple, but on the upper side of the nipple, where the presence of
the soft palate against it would sort of "mediate" the direction and
speed of the flow. I often found parents reversing the side of the nipple
so the hole was on bottom, against the tongue, which might have even been
better. I reasoned that this would avoid the
"straight-to-the-back-wall-of-the-throat" type squirt that the standard
nipples can give.

Wonder what would happen if someone made a nipple with a hole(s) out the
side rather than on the tip??? Oh, well, that's getting WAY OT!

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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