Dear Martha, when I worked in a hospital, we frequently saw babies who
wouldn't suck - probably at least once a week. Some of these were bottle
feeding babies. I don't know how many times I watched a nurse try to bottle
feed a baby and get nothing down him or her. Most of these were full term. I
get a handful of these babies every year as a WIC LC.

Wolfe and Glass say that the ability to suck,swallow, breathe functionally
is finished in utero at 38 weeks. Now how many babies have you seen that are
induced or planned c-section that seem not ready to funtion out of the womb?
Meaning not good eaters, sleepy, or very fussy.

Secondly, as Linda Smith discussed in her "Why Johnny Can't Suck" session at
the 2004 LLL of Texas Area Conference, lots of times the way babies are
pulled out of the womb or birth canal can do some sublte nerve damage to the
head, neck, face and this might be why they aren't sucking. C-section babies
are pulled out under the head at the neck area and there are many nerves
running through this area. Linda could explain it better than I can. Forceps
or even long hard pushing can do some damage to the nerve endings in the
head, neck, and face, also. This is where cranio-sacral therapy can be of
value.

Thirdly, lets also talk about suctioning. Babies are suctioned often with
the tube down their throat and many of these go on to be adverse to sucking
and swallowing. You combine any of these problems with medications in labor
like demoral, and we just might have a baby who has a reduced sucking
instinct.

In my opinion, the Avent is not for those babies who have weak sucks. They
get very little for their efforts on that bottle/nipple, or so I have seen.
I like to use something a little softer or faster flowing for babies with a
weak suck. A Haberman often works very well if the baby can at least "chomp"
to start removing milk.
So, to wrap up my thoughts, poorly sucking or no sucking babies are nothing
new. Some of them are having issues with how they were birthed or what
happened afterwards. Some of them will have weak facial and mouth muscles
and need OT or SLP help. Some of them might have physical health issues like
heart problems.

Kathy Eng, BSW, IBCLC

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