Jennifer,

In Wolf and Glass' book, Feeding and Swallowing Disorders in Infancy,
thickening foods to facilitate swallowing is mentioned several times. This
is not my area of expertise but I have worked with many babies like this.
They all couldn't breastfeed (either well or at all) due to not being able
to coordinate their suck, swallow, breathe mechanism or not being able to
swallow properly. They might latch but not remove much milk. Test weighing
is vital if mom wants to try to breastfeed. She can rent a Baby Weigh Scale.
Thicker foods are easier to form into a bolus and then swallow. The way food
goes down is that the mouth and tongue form the food or liquid into a bolus
at the base of the tongue near the throat. The throat then opens, the tongue
drops and the food goes down. The idea of thickening liquids is common to
help these babies swallow easier.

I would also suggest trying a Medela Haberman feeder because babies can
compress to get the fluid rather than just sucking and the flow rate is
variable, and baby can control the flow herself. Babies who have trouble
forming boluses and swallowing have done well for me on a Habermann feeder.
These are babies who couldn't manage a regular bottle and nipple or didn't
remove much from the breast. I am not sure thickened milk can go through the
Haberman valve, though.  I suggest moms feed baby first and then let baby
latch to the breast for comfort afterwards. Most of the babies I have worked
with had poor stamina so putting them to the breast first meant little
intake and then baby shut down (went to sleep) without a good feeding
therefore too much weight loss or poor gain.

If mom is willing to keep pumping 6-8 times in 24 hours with a rental pump,
she can try waiting it out. If baby is aspirating up his nasal cavity, then
breast milk without thickener is certainly better than formula. I look for
little white balls of mucous in the nose plus "snotty" sounds without a
runny nose or cold symptoms. Also I have heard stridor or wheezing sounds
after feedings from the babies that I suspect have some kind of oral motor
or swallowing/aspiration type problems.

Best wishes to this mom. Kathy Eng, BSW, IBCLC

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