Red Flags for Oral Dysfunction/Weakness affecting feeding
- Prolonged feeding times (beyond 30-45 min in first month of life, by 2 months old, 20 min every 2-3 hours); excessive tiredness/sleepiness; keeps eyes closed while feeding; falls asleep while feeding
- Prefers one breast vs both and a head turn preference
- High/narrow palate, sucking blisters/blanched lips, keeps tongue retracted
- Doesn’t seem satisfied after feeding; feeds frequently
- Gassy, hiccups, reflux
- Difficulty latching, staying latched, falls off breast, slides off bottle nipple
- Difficulty coordinating suck-swallow-breathe, frequent pauses
- Tongue clicking or noisy feeding; coughing/gasping/sputtering; difficulty with flow
- Milk dribbles out of mouth, poor seal with tongue and lips, excessive drooling
- Lips roll in instead of flanging on nipple
- Difficulty holding a pacifier-especially the “Soothie” brand which is longer narrow cylindrical shape (or can only hold onto a flat/orthodontic type nipple)
- Difficulty accepting bottle- tried many different types- only able to feed from short,
- Flat, or orthodontic-shape nipples; gags on longer narrow cylindrical shape
- Chompy feeding-excessive use of jaw, biting
- Poor milk transfer or high expenditure of energy to feed resulting in failure to thrive
- Impact on mother’s milk supply due to poor feeding at breast-need for supplementation; or seemed to breastfeed fine until around 3-4 months and then milk supply became an issue
- Maternal complaints of pain, discomfort, compressed/soar/cracked/bleeding nipples
- Maternal issues with blocked ducts, mastitis, thrush
- Some babies learn to compensate at the breast, but then can not take a bottle
For many moms, breastfeeding is their number 1 goal. Some babies struggle to get started with breastfeeding due to weaknesses. For those babies, a dropper or oral syringe is a good way to provide milk without introducing a bottle
Tips for using a dropper/oral syringe include:
- Place the baby on your lap, in an upright, sitting position. Be sure to safely support the baby’s head. Many babies prefer to FACE you, rather than being in the cradle position which the baby associates with nursing. Some parents prefer to swaddle the baby so the arms are not “flailing” or waiving around & in the way, but we never had trouble with hands/arms getting in the way.
- Use a small dropper/syringe and insert only slightly, gently, into the baby’s mouth. Some babies do better with it between the cheek and gums.Others do just fine with it laying gently inside the lower lip.
- Gently squeeze the dropper/syringe, allowing a small amount of breast milk to enter the baby’s mouth. At first it’s just “drops” at a time, but as baby (and you) get better at it, more can be offered at a time
- Wait for the baby to swallow. The baby may occasionally spit some of the breast milk out.
- Once you and baby get the hang of this, it is not hard nor does it take an excessive amount of time to feed the baby. As a matter of fact, it’s one way to really interact with the baby while the feeding process is going on
If the struggle to feed lasts more than 1 week, and the baby has no other congenital diagnosis or trauma from birth, Infant Feeding Therapy is an excellent way to learn how to help the baby develop his/her reflexes and muscles that are weak, resulting in difficulty with breastfeeding.
Breastfeeding is the best indicator of potential issues with speech/feeding, as a bottle does not use the same muscular structure/function, therefore cannot mimic the needed prompts for development of tongue, cheeks, lips and jaw. Later, this can result in difficulty propelling the puréed from front to back of the mouth to swallow, gagging on solid trials, picky eating, and delayed speech.
With early identification, an infant feeding evaluation, treatment and discharge is, on average, 6 sessions. If there are other underlying diagnoses, or if the baby is older, this amount of sessions may increase. However, with the right treatment plan, and follow through of the parents/family with the recommended exercises given during the sessions, progress is rapid due to the infant’s innate desire to learn and integrate their primitive reflexes.
There are only a few Infant Feeding Specialists in town. Kelley Carter is one of the few with advanced courses completed in Oral Feeding, Tongue Tie, Picky Eating, Orofacial Myology and more. Most treatment plans are between 2-6 sessions max based on the age of the child, the severity of the deficits, and more.
A feeding specialist can help determine a need for Pediatric Dentist referral for Tongue Tie release following a few therapy sessions to avoid oral aversion and begin the strengthening of the oral muscles prior to a release, Physical Therapy for possible Torticollis, Bodywork for tightness, and Lactation for breastfeeding mom/baby dyad to maximize positioning and problem solving in collaboration with the Infant Feeding Specialist.
Feeding therapy usually covered by Insurance and/or Medicaid with a Doctor’s Referral
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