NOTE: If your baby is experiencing long difficult feedings, gulpy swallows, liquid spilling from the mouth, spitting up excessively after feeding, choking, cough, congestion that increases with feeding, feeding aversion, clamping down on the nipple to stop flow rate...contact your physician. These are signs of problems with feeding and possibly issues with safety of the swallow.
1. Swaddle the baby securely. A larger baby can be swaddled firmly around the hips and the blanket can go around the mid-upper arms for good stability to the body. Swaddling provides boundaries around the body and is good for helping the baby maintain an organized state while feeding. It also supports the body and lets the muscles of the mouth work optimally.
2. Elicit the root reflex by stroking down the lip with the bottle nipple, stroke twice, rather firmly and wait and see if the baby opens the mouth and drops the tongue. Elicit the root again. This reflex is very important when feeding. You may also want to briefly offer a pacifier and get your baby sucking well and then transition to bottle. But elicit the root reflex again, don't just poke the bottle in the mouth.
3. A slight side tilt position can be very helpful. This mimics breastfeeding positioning and the milk will move to the side of the cheek and then back for swallowing instead of falling right over the base of the tongue and into the throat.
4. Tip the bottle nipple down for a few seconds to empty it of formula or breastmilk if your baby is gulpy or getting too much. This is called pacing of the feeding. Your baby needs to learn to stop and take a break and swallow. External pacing by the feeder allows the baby to get a much needed breath. Yes, there is some air ingestion, but this is a non-issue compared to aspirating the feeding.
5. Use a good slow flow or medium flow nipple if your baby can handle that rate. The baby should not have milk spilling from the mouth. You do not want to see wide eyes, watery eyes or hear gulpy swallows. Many babies do better on a slow flow product. We like the Gerber silicone products in slow and medium, Parent's Choice 0+ for babies with reduced lip seal, the Dr Brown Level I slow, level II medium flow nipples. If you are using cereal, blenderize the flakes so the cereal is a fine powder. The Dr Brown Level III and IV nipples can be used for cereal feedings. If you are using Simply Thick, we have concerns about this product (see blog for articles). Make sure you are whisking this product with a fork or mixer. Do not shake. We do not like using thickened feedings unless absolutely necessary and recommend instead that therapy begin to work on improving swallowing skills. Never, under any circumstances slit, cut or enlarge the hole of a nipple. This is an unsafe practice and in the hospital, considered tampering with medical equipment. Flow rate will continue to increase and cannot be regulated. This creates a risk for aspiration.
6. Keep feedings within 20 to 30 minutes maximum. Long feedings burn energy and calories. If your baby is struggling with growth, contact your physician and see about a visit to a pediatric dietitian for assistance.
1. Swaddle the baby securely. A larger baby can be swaddled firmly around the hips and the blanket can go around the mid-upper arms for good stability to the body. Swaddling provides boundaries around the body and is good for helping the baby maintain an organized state while feeding. It also supports the body and lets the muscles of the mouth work optimally.
2. Elicit the root reflex by stroking down the lip with the bottle nipple, stroke twice, rather firmly and wait and see if the baby opens the mouth and drops the tongue. Elicit the root again. This reflex is very important when feeding. You may also want to briefly offer a pacifier and get your baby sucking well and then transition to bottle. But elicit the root reflex again, don't just poke the bottle in the mouth.
3. A slight side tilt position can be very helpful. This mimics breastfeeding positioning and the milk will move to the side of the cheek and then back for swallowing instead of falling right over the base of the tongue and into the throat.
4. Tip the bottle nipple down for a few seconds to empty it of formula or breastmilk if your baby is gulpy or getting too much. This is called pacing of the feeding. Your baby needs to learn to stop and take a break and swallow. External pacing by the feeder allows the baby to get a much needed breath. Yes, there is some air ingestion, but this is a non-issue compared to aspirating the feeding.
5. Use a good slow flow or medium flow nipple if your baby can handle that rate. The baby should not have milk spilling from the mouth. You do not want to see wide eyes, watery eyes or hear gulpy swallows. Many babies do better on a slow flow product. We like the Gerber silicone products in slow and medium, Parent's Choice 0+ for babies with reduced lip seal, the Dr Brown Level I slow, level II medium flow nipples. If you are using cereal, blenderize the flakes so the cereal is a fine powder. The Dr Brown Level III and IV nipples can be used for cereal feedings. If you are using Simply Thick, we have concerns about this product (see blog for articles). Make sure you are whisking this product with a fork or mixer. Do not shake. We do not like using thickened feedings unless absolutely necessary and recommend instead that therapy begin to work on improving swallowing skills. Never, under any circumstances slit, cut or enlarge the hole of a nipple. This is an unsafe practice and in the hospital, considered tampering with medical equipment. Flow rate will continue to increase and cannot be regulated. This creates a risk for aspiration.
6. Keep feedings within 20 to 30 minutes maximum. Long feedings burn energy and calories. If your baby is struggling with growth, contact your physician and see about a visit to a pediatric dietitian for assistance.