Friday, April 29, 2016

The Difficult Feeder

Breastmilk is well established as optimal nutrition for nutritional, immunologic, and psychosocial child health. The ability of the newborn to latch and suckle effectively at the breast is critical to establish successful breastfeeding. Some newborns have significant difficulty, often related to anatomic and musculskelatal problems, thus requiring referral to specialists who have expertise in correcting newborn breastfeeding problems including lactation consultants, occupational therapists and physicians trained in the musculoskeletal basis of feeding dysfunction.

To address these issues, The San Diego County Breastfeeding Coalition (SDCBC) hosted a mini-seminar earlier this month for physicians and other health care providers. The purpose of this seminar is to familiarize maternal and newborn health providers with the types of expertise and interventions that different specialties—lactation consultants, occupational therapists, osteopaths—can offer and to aid in appropriate referral in order to assure successful breastfeeding.

Many issues might prevent a newborn from achieving a deep, effective latch to a normal mother’s breast. SDCBC’s Rose deVigne-Jackiewicz (RN, MPH, IBCLC) pointed out that premature babies and babies with real anatomical issues or jaundice are among those difficult feeders. An IBCLC should be able to recognize a “normal latch,” and form the strategy to establish a normal breastfeeding. She also believes that when having a long-term feeding plan, reasonable supplement and bottle usage is okay.

Bottle can be necessary when supporting the breastfeeding relationship for the infants who is hospitalized. However, “no nipple that resembles breastfeeding, ” said Robyn McMasters (MS, OTRL, SWC, CLEC) of Rady Children’s Hospital. She suggested evaluate every mother and baby before recommending a certain bottle system.

Bottle and breast are two different feeding systems. In strategies of supporting the transition to breastfeeding, McMasters recommended “educating moms early on being at bedside and participating in cares,” “kangaroo care,” “oral care with EBM,” and “exposure to breast.” Kangaroo care, also known as non-nutritive suck, can be a good transition to breastfeeding.

DeVigne-Jackiewicz said that an IBCLC should also be willing to acknowledge what s/he doesn’t know, refer the mom and baby promptly, and know who can refer to. This is where the cranial sacral therapy and osteopathic care kick in.

Cranial Sacral Therapy is a gentle, noninvasive form of bodywork that addresses the bones of the head, spinal column and sacrum. The goal is to release compression in those area which alleviates stress and pain. Cranial sacral therapy, said Bridgette K. Chelf (DC, CST) can help breastfeeding infants, for there are at least five bones of the cranium that effect suck. They are frontal bones, occipital bones, parietal bones, temporal bones and sphenoid bones. These bones also relate to nervous system that effect suck. When these bones are properly adjusted, baby’s sucking motion can be improved.

Dr. Hollis H. King (DO, PhD) introduced an osteopathic approach to treating the difficult feeder at the seminar. From his perspective OMT in pediatrics begins not at birth, but during pregnancy.

Dr. Viola Frymann, the founder of Osteopathic Center for Children, once said that the most important thing to do in treating children is to treat the mothers during pregnancy. Prenatal OMT helps the delivery process. And a traumatic delivery can result in somatic dysfunction that can have long term affects on the child.

Even delivered smoothly, 73% of newborns had at least one asymmetry, 10% had more than one. Both somatic dysfunction and asymmetry can lead to breastfeeding difficulties. They can both be corrected with osteopathic approach.

Eating is a learned behavior. Normal babies aren’t born with eating skills, they born with reflexive ability. The establishment of effective and successful breastfeeding often needs assistance from IBCLC and other professionals.

This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng. Photo credit to Mu-huan Chiang.

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