WHEN FEEDING BABY SUCKS…
When a woman gets pregnant, she often has this perfect picture in her head of what motherhood will look like. We often plan to breastfeed and difficulties just don’t cross our mind. Fortunately, in today’s world, we have access to formula if baby struggles to gain weight and an industry ready with many different products (bottles, nipples, pacifiers) to “fix” baby’s feeding issues. Why do some babies struggle with feeding? What happens when baby accommodates or adapts to succeed at feeding? What if these adaptations do not work?
Let’s chat about a speech language pathologist’s (SLP) role in infant feeding. We often hear infants struggling to feed are initially referred to a lactation consultant or an occupational therapist. Each of whom are wonderful resources who approach feeding with a different perspective and educational background. I often think of a lactation consultant being an expert in breastfeeding. An occupational therapist may have specialized training in infant feeding. So, where does an SLP fit in?
SLPs have been highly trained in the structure and function of the mouth, and the scope of practice includes swallowing. Multiple SLPs at Chatterbox Speech Therapy have furthered their education in this area by attending courses in orofacial myology (the study and treatment of muscular dysfunction of cheeks, jaw, lips, and/or tongue) as well as suck retraining and/or Guided Oral Movements and Active Patterning (GOMAP). What does this mean in the world of infant feeding? Well, we will join the team with an educational background that has centered around baby’s mouth: what it should be doing, how it should be doing it, and why it should be doing it that way. We may also be able to share information on how current dysfunction MAY impact baby’s oral function in the future.
Why would baby need feeding therapy? That is a great question! Let me share with you red flags that I listen for when I am chatting with my families:
For breastfeeding moms:
- baby is struggling to gain weight
- white coating on the tongue (milk tongue)
- any nipple or breast pain reported by mom
- the need of or nipple shield or other compensatory tools
- baby unlatches often or requires breaks while feeding
- baby does not seem satisfied following a feeding
- baby refuses to latch on one side
- baby takes longer than 30 minutes to complete a feed
- baby spills milk out of his/her mouth while feeding
- mom experiences clogged milk ducts or mastitis
- baby “clicks” while eating
- baby does not maintain a suck on a Soothie pacifier, or prefers a round, flat nipple on a pacifier
For bottle-feeding moms:
- poor weight gain
- baby requires a certain bottle or nipple to feed successfully
- white coating on the tongue (milk tongue)
- baby spills milk out of the front of the mouth
- baby “clicks” while eating
- baby coughs/gags or requires breaks while eating
- baby takes longer than 30 minutes to finish a bottle
- baby does not maintain a suck on a Soothie pacifier, or prefers a round, flat nipple on a pacifier
When I hear a parent or caregiver discuss any of the symptoms mentioned above, I know that something in baby’s mouth is not functioning correctly. Your baby should be able to latch to the breast or any bottle easily, transfer milk efficiently with no pain or spillage, complete a feeding in 30 minutes or less, and feel satisfied afterwards. If this is not the case, then baby is not laying appropriate groundwork for future feeding skills and is instead learning maladaptive compensatory strategies. This means that when it comes time to start transitioning to purees/table foods/adult-like meals, we MAY have a difficult time. This can lead to picky eating, behaviors at the dinner table, and slow eating, among other things. We may also begin to see delays in speech, language, or both.
If your baby is experiencing any of these symptoms, you might be wondering what to do next. It is always a good idea to have a conversation with your child’s primary care physician about your concerns. If you decide that you feel that your baby would benefit from a feeding evaluation, it is important to find a professional who is skilled in working with infants. An infant feeding evaluation may go something like this:
Completion of a feeding evaluation, including thorough assessment of the infant’s oral structure (lips, gums, tongue, cheeks, trunk, head, neck, hard palate and soft tissues) and followed with a functional feeding evaluation. I ask parents/caregivers to feed baby exactly how they are fed at home. From there, if I see any concerns, they are discussed, therapy is scheduled, and a plan of care is developed. I will always provide home programming that is updated weekly to ensure baby’s changing needs are being met as they progress through therapy. It is amazing how quickly progress can be made when home programming is completed regularly!
If you have any questions or would like to schedule an appointment, please do not hesitate to give us a call! We would love to see you in our office!
By Amanda Littrell, M.S. CCC-SLP