POOR FEEDING
A very common sign of Neonatal Abstinence from any substance exposure is Poor Feeding which may (or may not) be because of other signs such as suck/swallow difficulties or regurgitation/vomiting. This can include things like gagging, coughing, slow feeding or poor suck. It is important to determine what is contributing to the poor feeding so that you will have the right strategies. Poor feeding can lead to what is called ‘failure to thrive’ when a baby is not growing and gaining weight. It is important that you seek medical advice if your baby is not gaining weight.
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.
THE SOOTHE Technique
STRATEGIES BY DISCIPLINE
NEURODEVELOPMENT
First consider all the physical reasons for the poor feeding and discuss with your baby’s doctor.
Keeping them calm during feeds will help. You may want to swaddle during feeding to decrease fussiness or motor movements so the baby can focus on sucking. (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.
It is important that the environment is not over stimulating for the baby during the feeds.
Make sure that it is quiet (no tv etc in background) and low lighting and only engage during breaks (burping, brief stops etc) in the feed so as to not require to much of your baby during sucking and swallowing.
If your baby has spitting up, constipation and nasal congestion it may be a sensitivity to the formula, and you may want to talk to your baby’s doctor about a formula change.
Read your baby’s cues (movements and behaviors) to know what your baby needs from you and so you can pace the feed.
MEDICAL
It is important to determine the root cause of the poor feeding with the help of your baby’s doctor.
Your baby’s doctor will want to know:
Does your baby have a coordinated suck/swallow/breathe pattern.
They will track your baby’s weight
They may give your baby a higher calorie formula
Check to see if your baby is gaining weight. If the baby is not gaining weight, you should call your baby’s doctor for assistance.
You may want to talk to your baby’s doctor about potential allergies OR food sensitivities.
Your baby’s doctor MAY recommend that you shorten the feeding intervals and lessen the amount at each feed to help the baby be able to tolerate the feeding.
You may need to put the infant on a schedule with more frequent, less amount feeds; you may need to wake them to feed. Consult with the baby’s doctor.
Make sure you are feeding the baby in a calm and quiet place.
NURSING
It is important to determine the root cause of Poor Feeding. If you are unsure or your baby is not gaining weight you need to call your baby’s doctor’s office.
Monitor your baby’s weight carefully.
Monitor your baby during feeding to make sure they don’t gag or choke. Also keep your baby in an elevated position for at least 30 minutes after feeding.
Your baby may have a food sensitivity and you should ask about changing formula with the baby’s doctor.
You may need to have smaller more frequent feedings as tolerated by your baby.
OCCUPATIONAL THERAPY
Swaddle your baby during feeding to decrease involuntary movement which helps babies to focus on eating more. Swaddling also helps to organize and calm your baby so that he/she can fully focus on suck/swallow and breathing. Make sure the swaddle 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.
Elevate with a small incline (wedge under the mattress) where your baby lies down so that the acid (spit up) can travel back down to the tummy, thus preventing the burning to the esophagus and reducing the amount of spit ups.
Keep the baby upright for 30 minutes after feeding. This will help food to settle into the tummy and reduce the risk for reflux episodes. Do not put the baby to bed right after feeding. When the baby lies down, food is more likely to travel back up the throat. So, aim to make your feeds at least 30 minutes before sleep time.
SPEECH PATHOLOGY
The baby will likely need smaller and more frequent feeds to help them keep their food down.
Also do more frequent burping to assist with digestion.
Always make sure the head is higher than the hips when feeding and for at least 30 minutes after a feed.
No bouncing during or right after feeds.
Offer your baby a pacifier at times other than feeding to help them learn to better coordinate their suck/swallow/breathe patterns.