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