Dear Jan,

With regard to the 5 month old refusing bottles, and basically refusing
to eat about whom you posted on Oct. 13.

Last spring at the annual Albuquerque conference on Breastfeeding and
the High Risk Neonate, Margery Palmer, author of the Neonatal Oral Motor
Assessment Scale, was one of the speakers. She talked about babies who
have had unpleasant feeding experiences refusing to eat when they
transition from reflex to volitional sucking at about 3-5 months (It was
around there, haven't looked up my notes.)  This would include babies
who had been force fed in the nursery to get down a certain volume,
especially when their cues to stop the feeding were being
ignored--babies who had reflux, respiratory distress (and not allowed
enough time between sucking bursts), etc. and nurse kept pushing baby to
eat when his eyes were bugging out, he's turning red, and giving other
signs of distress.  I suppose this could happen at home as well, but I
think most mothers are more tuned into their babies and would be less
likely to force feed.

Anyway, Ms. Palmer said these babies usually end up with gastrostomy
tubes for feeding.  She discussed feeding these babies with a soft, flat
dropper and depositing liquid one drop at a time in his cheek (to avoid
his needing to open his jaw).

If this problem hasn't been resolved (and since I'm so far behind, this
is probably more beneficial for general education than for this
particular baby, who by now is no doubt either better or being treated),
I would think referral to a speech therapist or occupational therapist
with special training in infant feeding would be appropriate.

Sorry about that last sentence.  I love e-mail.  It is apparently
permissible to write as you think or would talk without the restraints
of formal grammatical structure.

Hoping the strike has already been resolved and that it is nothing as
serious as this.

Bonnie Jones, RN, ICCE, IBCLC
from the sunny S.W. USA