APPENDIX 7: Early Infant Feeding and Swallowing Difficulties

Table 23: Early Infant Feeding and Swallowing Difficulties: Where to start when problems arise

DIFFICULTY	PRESENTATION	WAYS TO CORRECT AT BREAST	WAYS TO CORRECT ON BOTTLE
Fast flow	choking gulping milk spilling from mouth coughing pulling off of the nipple wet, gurgly voice	laid back or high football position pump through let-down prior to latching (pump for 2 minutes)	try slower flow nipple swaddle hold close to body elevated side-lying position
Poor Pacing	sucking without breath breaks apneic events gulping milk spilling from mouth	pace externally by un-latching allow babe to recover and try again	pace externally (remove bottle from mouth) allow babe to recover and try again try slower flow nipple swaddle hold close to body elevated side-lying position
Poor Latch	milk spilling from mouth mouth not sealing on nipple clicking sounds with suck shallow latch (not enough breast tissue in mouth, nipple only) pulling off and on the nipple baby fussy discomfort/pain for mom	breast shaping to ensure deeper latch repositioning Mom and babe, with supports ensure proper latch and position: align nose to nipple and ensure wide open gape prior to latching	ensure optimal position as above if nipple appears small in mouth, trial larger nipple base bottle
Poor Milk Transfer	baby fussy pulling off and on the nipple few/no evident swallows blanching of lips poor weight gain low/decreasing milk supply refusing to latch	ensure mom and babe calm prior to latching ensure proper latch and position as above breast compressions with sucking assess milk supply	trial faster flow nipple ensure optimal position as above