EXCESSIVE OR FRANTIC SUCKING

One of the common symptoms of Neonatal Abstinence from any substance exposure is excessive or frantic sucking. This is seen when the baby has an uncontrollable need for sucking. They may try or seek to suck on their fists, bottle or clothing. Excessive sucking can lead to their hands having sore from the skin breaking down. Sometimes their head may move frantically from side to side; typically seeking for something to suck and it may be that their tight muscles may interfere with their ability to suck on their fists. It is important to know that your baby may make sucking motion with their mouth. Sucking is calming to the central nervous system, and it does not necessarily mean that your baby is hungry. Teaching your baby how to use a pacifier when they are not frantically sucking will be important so that the pacifier can be more effective when they are in distress and/or to help maintain a calm state.

*REMEMBER that sucking is a way of exploring the environment and so some sucking will be normal for baby’s. This may also be seen when they are teething. But excessive sucking is uncontrollable and frantic.

NOTE: The Following Videos found in this kit under the Parenting Tips from Specialists will provide more information and/or demonstration that might be useful for some of the interventions recommended here.

NAS: Early Interventions

The SOOTHE Technique

Sucking and Feeding Devices

NAS and Feeding

NAS and Movement

STRATEGIES BY DISCIPLINE

NEURODEVELOPMENT

  • First consider all the physical reasons for excessive sucking and take steps to address those while you offer immediate comfort.

  • Helping your baby to use a pacifier will be very important.

  • To soothe your baby one of the best calming strategies is the SOOTHE technique developed by Dr Kiti (a video demonstrating the soothe is available under TimeIn Parenting Strategies (TIPS) in this kit).

  • Swaddling is a very important and helpful tool in calming an infant (the Ollie swaddle was specifically designed with the NAS baby in mind as it offers moisture wicking, and stretch with pliable restriction). Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in if the baby can roll over.

  • MAKE sure to read and respond to the baby’s cues to inform your intervention or interventions. Remember that sometimes you may need to help your baby learn to calm with step by step calming techniques.

MEDICAL

  • It is important to determine the root cause of excessive sucking. If you are unsure you need to call your baby’s doctor.

  • Check to see if your baby is gaining weight. If you think that the baby is hungry and not gaining weight should call your baby’s doctor for assistance.

  • Recommended interventions:

    • Use a pacifier to help with need for sucking (which helps the infant calm)

    • Comforting techniques (offered in this kit)

    • Your baby may not be getting enough food;

  • Make sure your baby’s suck is productive (they can attain breastmilk/formula and swallow it)

  • If your baby is having trouble with a productive suck - shorten the feeding intervals to not tire the baby out

  • You may need to put the infant on a schedule with frequent, less amount feeds; you may need to wake them to feed.

  • If the baby’s skin is wearing down, you may want to use a sleeve with mitts. However, this should be used only if skin is wearing down and only when the baby is not monitored (sleep) as it interferes with thumb/finger development.

NURSING

  • It is important to determine the root cause of irritability. If you are unsure or symptoms do not go away, you need to call your baby’s doctor’s office.

  • Make sure the skin does not break down – ask your baby’s doctor’s office for ways to do this.

  • Swaddle with a pacifier to help your baby stay calm. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in for sleep if the baby can roll over.

OCCUPATIONAL THERAPY

  • Use a Pacifier to offer your baby a way to calm with sucking.

  • Swaddle (helps to limit the sucking and provide calming) Make sure it is not too tight (fabric should provide stretch so it doesn’t harm shoulders or hips) but provides flexible restraint. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in for sleep if the baby can roll over.

    • Change the position – some positions may actually feel painful while the infant is going through abstinence. Be aware of what positions are more calming.

    • Infant massage may be helpful to provide calming and reduce the need for frantic sucking.

SPEECH PATHOLOGY

  • It will help to teach them to use a pacifier. Sucking is very calming to the nervous system. You will need to teach them to use a pacifier when they are calmer, so they learn to coordinate their sucking rather than just spit it out. “Spitting it out” is due to not being able to coordinate the suck, swallow, breathe (SSB) rhythm resulting in the pacifier fall out and/or frustration.

  • Swaddle. Make sure to use safe swaddling instructions offered by the manufacturer AND do not swaddle arms in for sleep if the baby can roll over.

  • It can be that the baby is hungry and is not able to take in a sufficient amount of food. Often babies with NAS have trouble with their suck while feeding.

    • Babies feed to a rhythm, and the development of this coordination is called suck, swallow, breathe (SSB). They may need you to restrict their movement during feeding (especially if they have tremors or body shakes) so that they can focus their movement on coordinating their SSB and be able to feed better.

    • Shorter and more frequent feeds may be important to help them with endurance when they have trouble with their suck.

    • You may want to ask your baby’s doctor for a referral to a speech/language therapist or Occupation therapist who has experience in feeding training.