Cup Feeding Strikes Again! - page 4

So I had this lovely little guy, about 3700 grams, term, some meconium staining at birth, otherwise completely boring pregnancy and vaginal delivery. He had some low blood sugars (which we call... Read More

  1. by   Sweden
    Quote from lovemyjob
    Sweden, do you thicken feeds for your preemies with poor suck/swallow and use the cup method? I would imagine a kid who was having problems aspirating would have a more difficult time with the cup because it would flow faster.
    No we dont thicken the food. All preterm babies are on breastmilk, either mums own or donated. With the correct tecnique the milk should/will not flow faster than the baby wants it to.

    I have never seen a baby not allowed to cupfeed beacause they are proned to aspirating food (unless there is a medical reason behind it ofcourse).

    Anna
  2. by   lovemyjob
    Quote from Sweden
    No we dont thicken the food. All preterm babies are on breastmilk, either mums own or donated. With the correct tecnique the milk should/will not flow faster than the baby wants it to.

    I have never seen a baby not allowed to cupfeed beacause they are proned to aspirating food (unless there is a medical reason behind it ofcourse).

    Anna

    Do you ever do a modified barium swallow study on kids who brady during feeds?
  3. by   prmenrs
    Kids who brady during feeds are not quite mature enough to be fed---they haven't got the part about "stop sucking so I can swallow what I have in my mouth". You can help them by sitting in front of the monitor (so you can see what/how they're doing) and literally counting the sucks. @ about 4-6 sucks, either tip the bottle down or take it out so they swallow.

    I haven't seen them do this as much when they are breast feeding. Breastfeeding and kangaroo care can go hand in hand. The baby is in the neighborhood anyway, and can decide to suck when they want to. They should try sucking the first time AFTER mom has pumped--if she's really full and "lets down", the baby will practically drown!

    W/a mom who's complaining she's not getting as much when she pumps (often happens @ ~ 1 month), let the baby help increase her production by suckling.
  4. by   lovemyjob
    we have kids occassionally who are term (corected age) who have this problem, even some who were born term. If speech therapy thinks they might be aspirating during feeds, they will recommend a mbss. We will also do them so that the kid can go home. I think the idea is not they they fill their mouth so much that they dont swallow it all, I have seen them sucking/swallowing and still bradying. I am not really sure what makes the milk go down the trachea, but i think it might be a problem with the swallow not being effective. Our kids who have the problem may go home on thickened feeds, or NG feeds till they develop a better swallow. They are monitored by speech therapy after d/c and progressed with ST guidance. I have also read that kids who go to the home environment will witch to PO feeds faster than if they are in the hospital, so our docs try to let it not stop them from going home, if that is their only problem.

    I cant imagine kids being sent home who have known problems with aspiration and the only giudance fpor parents is a # of sucks per burst allowed. Is that how they are sent home, or is that just a guide for nurses. We monitor closely during PO feeds and if they brady the bottle is removed till they "catch their breath." But, if this happens and the baby does not self recover (stop sucking and breath without action on the part of the nurse....back patting for stimulation or removal of the bottle) then it is further investigated by speech and a possible MBSS.
  5. by   prmenrs
    The suck counting thing is an intermediate step. They should progress to pacing the feeding on their own. They are not sent home till they're ready.
  6. by   Sweden
    Quote from lovemyjob
    Do you ever do a modified barium swallow study on kids who brady during feeds?
    No, we dont. If a baby has problems during feeds (cupfeedings) we simply stop and give them some time before trying again. Cupfeeding is the preferred method but not the only one!

    Anna
  7. by   htrn
    I have to agree with OP - I hate cupfeeding. I don't think there is any such thing as NIPPLE confusion, but there is definetly something called FLOW confusion. Infants have to work until mom's milk comes down when they breastfeed and they get instant gratifation with a nipple, especially a preemie nipple. Makes me CRAZY!!!!

    I also have to say I am so tired of hearing "absolutely no pacificers" because I learned in the breastfeeding class..... But take him back to the nursery (screaming and chewing on his fingers) so I can sleep!
  8. by   ElvishDNP
    Quote from obrnheather
    I also have to say I am so tired of hearing "absolutely no pacificers" because I learned in the breastfeeding class..... But take him back to the nursery (screaming and chewing on his fingers) so I can sleep!
    Agree with you 150%! If I had a nickel for every time someone said to me "We don't want any bottles, formula, or pacifiers, but we want to sleep all night" I would be a rich rich lady.
  9. by   prmenrs
    I don't mind pointing out that there IS no newborn nursery, the baby stays w/you, and you get to be the mommy! Remember all the getting up 3-4x/night to pee the past few weeks? That was training for feeding the baby 24/7.

    We do allow ONE family member to stay and "help". How helpful they are is quite variable.
  10. by   wensday
    On nights there is a term used 'Magic Cup-feed'.
    It's a bottle.
    Those big low sugar babies that are starving but can't quite figure out the cup, because they are that hungry it just goes everywhere as they swing thier head from side to side, rooting. bit like a withdrawer. The kid is screaming all night cos he is so hungry.
    I don't agree with it but I've done it in the past.
    I love it when they cup feed really well though, it's the best feeling.
  11. by   ElvishDNP
    Quote from prmenrs
    Remember all the getting up 3-4x/night to pee the past few weeks? That was training for feeding the baby 24/7.

    We do allow ONE family member to stay and "help". How helpful they are is quite variable.
    I do tell people the bit about getting up at night being prep for being a parent.

    I have a hard time even documenting that there is familial support when Dad (or whoever) is sawing logs over on the pullout bed while Mom is sitting with bags under her eyes with a screaming baby. I call that "helping!" I know what you mean, prmenrs.
  12. by   Mags4711
    Calling it "nipple confusion" is just plain wrong. I haven't seen nipple confusion yet, and I've been at it for about 15 years. What I do see is babies who get used to the easy flow of the bottle and don't want to work at the breast. But they usually do fine after about a week or two of diligent work. We are shifting to the idea of first feeds for our preemies being breastfeeds (if mom is going to breastfeed, that is :spin: ) so that they can get used to the work and flow, and to help mom's milk come in or help her supply stay up.

    Cup feeding always seemed ridiculous to me.

    To answer the question about calories per ounce for breastmilk, I just learned tonight that the average is actually 21/oz and can be easily up to 27/oz. You can actually spin it and increase calories as need be without having to add fortifier.
  13. by   prmenrs
    Have you ever seen/done "creamatocrits"? It's a way of finding out how much fat is in a sample of breast milk.

    http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

    For a while, there was a great deal of interest as to which had more calories, "hind milk" or "foremilk", and which should be given to which babies.

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