BIG Babies
Little Eaters
© The Children’s Mercy Hospital, 2017
Objectives
• identify 2 common behaviors associated
with feeding difficulties of IDMs
• state 2 areas OT evaluates for feeding
• verbalize 2 treatment recommendations
for feeding plan
Feeding Evaluation – pre-bottle
• history of feeding – parents & nurses
• state of alertness
• vital signs
• muscle tone
• oral structures & function
History/State/Vital Signs
• usual report of starting off feeding well with
good interest -> done/no interest – may be awake
throughout or gradually sleepy
• OR – no cueing/no interest at all/decreased
interest
• may have unstable vital signs (increased WOB,
intermittent tachypnea) affect SSB coordination
with po
Muscle Tone
• often bigger babies
• “doughy” – often a bit low tone
• not typically true hypotonia
(neurological), can be more transient
Oral Structures & Function
• position, tone, movement, size, & shape of:
– cheeks
– jaw
– lips
– tongue
– palate
– may need oral stimulation to improve movement
Feeding Eval – Bottle Time
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•
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•
•
SSB
nipple
positioning
pacing
physical support
SSB Coordination
• NNS vs NS
• respiratory issues
– tachypnea/increased WOB -> do not po
– decreased RR due to decreased SSB coordination
• good suck, may decreased RR -> <HR &/or desats
• strategies to help with this (nipples, positioning, pacing)
Nipples – depends on SSB
• standard
• slow flow
Positioning - supportive
• sucking is a flexion motion
• swaddling provides good flexion posture
& containment of extremities
• head & neck are in midline
• unswaddle & re-swaddle to alert infant
Positioning – sidelying/elevated sidely
• Positions often used for babies having difficulty with SSB
• Gravity elimated/decreased slows flow of milk, stays in cheek
a little bit, allows more time to swallow
• Good to help keep tongue & jaw more forward if retraction is
an issue
• Gradually progress to 50-60, 60-70 upright/cradled
Pacing
• teaching SSB pattern by limiting the number of sucks,
stopping the milk flow, to allow time for baby to pause &
breathe
• may need to be done quite frequently, q 1-2 or 2-3 sucks,
as baby is learning how to coordinate SSB pattern
• may be needed throughout entire feed
Pacing
• as coordination improves, pacing may be provided
less frequently (q 3-5, 4-6 sucks)
• may just be needed at beginning of feed & after
burps (tend to “forget” they need to breathe
• may need pacing only initially or to mid-feed &
then can self-pace
• learning to self-pace takes time
Physical Support
• goal is for baby to not need support
• support provided only if needed
• usually only need to support under side cheek in
sidelying/elevated sideying positions
• cheek & jaw support -> passive feeding
• we do not want to feed a rock – goal is active feeding, not
doing whatever is necessary to empty bottle
Recommendations
•
appropriate individualized feeding techniques – positioning, pacing,
nipple type, time limit (30 minutes max)
•
? concentrate milk/formula to decrease volume
•
? q 3 hour -> q 4 hour feeding schedule
•
RESPECT infant’s signs of disengagement & do not push
•
education to parents & caregivers
•
be patient - baby needs TIME