Are you and your baby experiencing feeding difficulties?
Scientists are increasingly understanding how nutritive sucking is developed from studies of preterm babies. However, there is a lack of evidence-based support for how premature and term babies with feeding difficulties should be cared for (Lau, 2015).
Babies can feed well when their ability to suck, swallow and breathe is coordinated. This function matures at different times and rates (Lau, 2015).
Up to 25 to 45% of normally developing children and up to 80% of children with developmental delay, particularly those born prematurely, experience feeding difficulties (Bryant-Waugh et al., 2010). Feeding difficulties are hence very common and we see a lot of them in our practice.
Babies with feeding difficulties may be experiencing latch problems combined with fussiness at the breast. This can also happen with bottle-feeding. Most of these babies have no weight issues and are thriving. Parents often use ingenious strategies to make sure that their babies are getting enough milk. It is also very time-consuming and many feel that infant feeding has taken over their life, leaving little time for any leisure with their baby. This is particularly true for parents who are ‘triple feeding’ i.e. expressing milk, formula and breastfeeding.
We often as paediatric osteopaths observe these babies’ frustration as they are trying to transfer milk from the breast, which can make every feeding a stressful experience for both mum and baby. The baby is often not satiated and will fuss soon after feeding which is often attributed to wind or ‘reflux’.
Some babies we see in practice have been diagnosed with feeding difficulties because of tongue tie. They come to us because feeding problems prevail, even after a frenotomy (the procedure to divide the tongue tie) as there may be suspected musculoskeletal tension from birth. Often parents are told that the baby “has not learned to use their tongue properly because of the tongue tie”. This is the case with some babies, but there may be another reason why feeding has not improved.
The phenomenon of uncoordinated sucking, swallowing and breathing in the absence of any bio-mechanical issues (eg tongue-tie, birth strain of head and neck) can be due to immaturity of the central nervous system. The baby is unable to control the muscles that coordinate the mechanism for feeding also known as the nutritive sucking pathway (Amaizu et al., 2008; Lau, 2015). Suck, swallow and breathing coordination (SSBC) involves a range of muscles, bones and cranial nerves and it also involves the autonomic nervous system (Geddes & Sakalidis, 2015). A study of 50 babies with colic found an association with difficulties coordinating suck, swallow and breathing (Degenaar & Kritzinger, 2015).
The autonomic nervous system modulates the stress response in all mammals. Feeding difficulties can be incredibly stressful for a mother and baby, often leading to a vicious cycle of hunger, tension, stress, poor latching, hunger, tension, etc.
Sometimes calling in an expert to help with feeding can help. As healthcare professionals, we support mum and baby through feeding difficulties until baby’s nervous system and sucking skills mature after all physical and behavioral barriers have been addressed. Despite the fact sleep-deprived parents may feel like it lasts a lifetime, it only lasts a few weeks. You may not need to fix everything, and sometimes your baby simply needs a bit more time to adjust to the world around them.
References:
Amaizu, N., Shulman, R., Schanler, R., & Lau, C. (2008). Maturation of oral feeding skills in preterm infants. Acta Paediatrica (Oslo, Norway : 1992), 97(1), 61–67. https://doi.org/10.1111/j.1651-2227.2007.00548.x
Bryant-Waugh, R., Markham, L., Kreipe, R. E., & Walsh, B. T. (2010). Feeding and eating disorders in childhood. International Journal of Eating Disorders, 43(2), NA-NA. https://doi.org/10.1002/eat.20795
Degenaar, H., & Kritzinger, A. (2015). Suck, swallow and breathing coordination in infants with infantile colic. The South African Journal of Communication Disorders = Die Suid-Afrikaanse Tydskrif Vir Kommunikasieafwykings, 62(1), E1–E10. https://doi.org/10.4102/sajcd.v62i1.115
Geddes, D., & Sakalidis, V. (2015). Breastfeeding: how do they do it? Infant sucking, swallowing and breathing. Infant , 11(5), 146–150.
Lau, C. (2015). Development of suck and swallow mechanisms in infants. Annals of Nutrition and Metabolism, 66, 7–14. https://doi.org/10.1159/000381361
