Cup Feeding Strikes Again!

Specialties NICU

Published

So I had this lovely little guy, about 3700 grams, term, some meconium staining at birth, otherwise completely boring pregnancy and lady partsl delivery. He had some low blood sugars (which we call chemstrips or chems where I work), so they followed their protocal (the chem was still like in the 40's) and put the baby to breast and rechecked, well, turns out the average woman cannot really produce enough milk at hours after birth to raise that kind of blood sugar (sarcasm intended). So they followed their protocol and gave him formula, by cup, because we don't want nipple confusion. Problem is you can only really cup feed so much so he was getting about 20-30mls per feed.

I can understand this if it's like a one time event and gets the kid over the hump, but he had recurring low chems and when he finally dipped under 35 he bought himself a gavage feed and an admission to NICU. Of course we NICU folks aren't quite as concerned about nipple confusion as we are about say; brain damage so we proceeded to bottle feed the kid. So his lowest blood sugar during his entire admission was 63. He wolfs down 60-90 mls of either formula or breastmilk (turns out his mom's milk came in pretty early and abundant). We have had several admissions to our unit that could have been prevented had our General Nursery been permitted to use a bottle (cup feeding only used for babies that moms state want to breastfeed).

So to prevent the threat of nipple confusion this kid had to spend hours separated from his mother until we established that his blood sugars were stable whereupon we started having her breastfeed followed by a pc bottle. He will be going home a day late due to this silliness.

I am so frustrated with cup feeding !!!!!! We are getting frequent admissions of kids who develop tachypnea or resp distress after cup feeding (can you say aspiration?). I know I've ranted about this before, but here I go again.

Specializes in L & D; Postpartum.

Every time I hear about cup feeding, I think those babies should just be given a spoon and fork and be done with it! LOL, a little. Ever have a Dad want to be hooked up to the SNS? That did it for me.

I worked in NICU for many years, but not for a few years now, so not quite up to date. However, would like to mention a few points-

A newborn does not require a lot of fluids for the first 2 days, as their urine output is low-natural way to cope with the low fluid intake of colostrum.

Colostrum is high in calories to maintain blood sugar unless there is an added reason for excessive or chronic low blood sugar, eg. prolonged and complicated deliveries or if the mother is diabetic.

Colostrum is the best milk for the infants gut and is easily digested(using another mothers milk is not practiced anymore, due to risk of spreading diseases like HIV).

Preterm babies should be be encouraged to breast feed when well and have good sucking reflexes-we used to start them breastfeeding slowly and for short periods as not to tire them and therefore cause them to loose weight-they would combine nasogastric feeding with breastfeeding, as they would suck away on the breast and still have a slow feed through the tube, and increase breastfeeding times as they got stronger. The nasogastric feed would hopefully be the mothers expressed milk.

Full term babies that were apparently nipple confused if given supplimented feeds through bottles, in my opinion were over fed with formula, if in the first few days or were just exaused post delivery, or there was a latching problem-difficult nipples, or the baby had a slow/weak sucking reflex.

Jaundiced would appear in some babies mostly due to excssive break down of red blood cells in the body, and seldom due to dehydration.

If the mother is unable to feed her baby by breast to begin with, then she could try expressing colostrum onto a spoon, and spoon feed the baby. Cup feeding should only be used in chronic feeding problems, and therefore not encouraged.

An exausted mother may need a rest now and then, and cup feeding can help then-or the odd bottle feed. If the baby is healthy and has a good sucking reflex, the odd bottle feed should not cause feeding problems, as the healthy baby would naturally know the breast milk is better (sounds crazy but nature is wonderful, and like other living and reproducing creatures, the human being is driven by natural forces), plus, the healthy baby i'm sure would not prefer a milton soaked, hard teat over the soft, pliable, warm nipple which is attatched to their favorite person, who has that gentle touch and voice they have been used to hearing for the last few months.

It helps if mothers maintains a good diet, rests well inbetween regular breast feeds, and keeps the baby properly latched at the breast at each feed-this is encouraged if enough help is available to new mums.

Dehydration may not be a cause of hyperbili, but it can make it worse because the concentration is higher and they are not fed enough volume to stimulate the gut to excrete the bili in the stool. when the bili rises and the infant becomes more and more lethargic he is less likely to have a successful feeding at the breast to help with the dehydration or gut stimulation and what bili the gut is trying to excrete is reabsorbed, all compunding the problem.

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.

Specializes in NICU, Med/Surg.

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 don´t 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

No we don´t 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?

Specializes in NICU, Infection Control.

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.

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.

Specializes in NICU, Infection Control.

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.

Specializes in NICU, Med/Surg.
Do you ever do a modified barium swallow study on kids who brady during feeds?

No, we don´t. 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:rolleyes:

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!:banghead: :banghead:

Specializes in Community, OB, Nursery.

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!:banghead: :banghead:

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.

Specializes in NICU, Infection Control.

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.

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