Goal one is to change the position in which your baby is being fed. Mouths must always be lower than ears to prevent milk flow into Eustachian tubes. The bottle position is altered to introduce the nipple from below the mouth, vertically encouraging a slight chin tuck. In this position your baby draws the milk up the nipple predominately with tongue retraction. This position and retractive action prevents milk from flowing freely into your baby's mouth. Your baby no longer needs strong tongue protrusion to enable swallowing. It is also important not to make the hole in the nipple larger.
Can babies with weak suckle draw the milk into their mouths in this position? Yes, if you don't use standard glass bottles. Bottles with the disposable liners, in either 4-ounce or 8-ounce sizes, can be filled with either pumped breast milk or any variety of formula, and the air can be forced out causing a vacuum. This type of bottle can then be fed to your baby in an upright position. If your baby has trouble drawing the milk up because of weak suckle, you can facilitate the draw by pushing gently on the liner. This technique has been successful with even the most severely impaired babies. After a week or so you will be able to push less as the muscles will begin to get stronger.
What is not commonly known is that even children with severe low tone at birth, including Down Syndrome, are nose breathers. They maintain their tongues in their mouth and upon examination their tongues are not abnormally large. Orally, these children look pretty much like any other infant with the exception that they have a weak suckle. This critical observation draws us to the connection between feeding muscles and muscles of speech. In quick order, a cascade of events unfolds for these babies with weak suckle. Many mothers tell me they genuinely wanted to breast feed their newborn but were unable because the child had a weak suckle and/or the mother did not produce sufficient milk. Absent a medical problem, the difficulty is often that the child's suckle was not strong enough to stimulate the mammary glands into producing adequate milk flow.
In this scenario mothers are traditionally encouraged by physicians to use a bottle. Bottlefeeding is fine, when done therapeutically, but mothers should be given meaningful choices. Further, when bottle feeding is suggested for these infants, the hole in the nipple is often cross-cut or enlarged to make it easier for the infant to suckle. The child is held in the mother's bent elbow and the bottle is held on a diagonal, nipple down. Visualize this - the milk flows easily into the infant's mouth, but what stops the flow, allowing the child to swallow?
Tongue protrusion; myth #2. Excessive tongue protrusion is a learned behavior that creates a physical manifestation.
Keep visualizing this infant with low tone/muscle strength. There is a sphincter muscle at the base of the Eustachian tube whose function is to allow air to enter the middle ear. If weak muscle tone reduces the effectiveness of this sphincter muscle, then in the described feeding position, milk is able to enter the middle ear. The result: chronic otitus media; a primary causative factor in conductive hearing loss; myth #3
Fluid build-up in the middle ear, and the resulting infection, circumfuses throughout mucous membranes of the
respiratory system and frequently becomes the originator of chronic upper respiratory infections;
myth #4. The nasal cavity becomes blocked, the child transfers from nose breathing to mouth breathing and we have
myth #5.
The jaw drops to accommodate the mouth breathing, encouraging a chronic open mouth posture;
myth #6.
Because the tongue is no longer maintained within the closed mouth, the palatal arches have nothing to stop their movement towards midline and we end up with a high, narrow palatal vault, making full circle back to myth
#1. The child's tongue remains flaccid in the open mouth posture, at rest. Lack of a properly retracted tongue position is myth #7. This enlarged appearance of the tongue is therefore not genetically coded, but rather the result of a series of care-provider related responses to the very real problem of weak suckle.
Understanding this scenario provides insight into the characteristics seen in these children when speech and language therapists begin to work on correcting their multiple articulation disorders. Addressing the oral muscles/structure from birth offers a more effective, preventative therapy than the wait-and-see approach taken today. These physical features are not predetermined. Our therapeutic goal should be to normalize the oral- motor system through feeding beginning in infancy.
In infancy, nutrition is of primary concern. Our job is to balance nutrition, successful feeding and therapy. Goal one is to change the position in which the child is being fed. Mouths must always be lower than ears to prevent milk flow into Eustachian tubes. The bottle position is altered to introduce the nipple from below the mouth, vertically encouraging a slight chin tuck. In this position the child draws the milk up the nipple predominately with tongue retraction. This position and retractive action prevents milk from flowing freely into the child's mouth. The child no longer needs strong tongue protrusion to enable swallowing. It is also important not to make the hole in the nipple larger.
Can children with weak suckle draw the milk into their mouths in this position? Yes, if you don't use standard glass bottles. Bottles with the disposable liners, in either 4-ounce or 8-ounce sizes, can be filled with either pumped breastmilk or any variety of formula, and the air can be forced out causing a vacuum. This type of bottle can then be fed to the child in an upright position. If the child has trouble drawing the milk up because of weak suckle, you can facilitate the draw by pushing gently on the liner. When I have used this technique with even the most severely impaired children, it has been successful. After a week or so you will be able to push less as the muscles will begin to get stronger. Facilitation is generally eliminated within 3-6 weeks.
Originally published in Published in ADVANCE Magazine August 4, 1997; from Sara Rosenfeld-Johnson.
To promote proper bottle feeding, you'll need the bottles with the nontoxic plastic liners.
Once your baby is able to hold a bottle himself, in an upright position, these bottles are good, non toxic choices:
Plastic Bottles:
NUK Bpa-free Starter Set $24 at amazon
NUK Bpa-free 5 oz. 3 pack $12 at amazon
NUK Bpa-free 10 oz. 3 pack $18 at amazon
Medela Value Pack Bpa-free Feeding Gift Set $30 at amazon, breakoutbras, seagalsforchildren
Glass bottles:
Big Lots has glass bottles for great prices.
GreenGlass Baby Bottle Starter Kit, Ocean/Sky from Lifefactory $60 at oompa, amazon,
NUK Silicone Orthodontic Nipples, Slow Flow, Size 1, 2 Pack $2.50 at amazon, shopcrownhouse
NUK Silicone Orthodontic Nipples, Slow Flow, Size 2, 2 Pack $2.50-5 at shopcrownhouse, amazon
