SUCK SWALLOW DIFFICULTIES
Over half of the infant with Neonatal Abstinence from any substance exposure have suck/swallow difficulties. This is seen when the baby has difficulty coordinating their suck and swallow. This can also be seen when the baby has weak muscles around their mouth. When the baby has suck or swallow difficulties they may have drooling, choking, difficulty breathing and/or gagging.
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.
STRATEGIES BY DISCIPLINE
NEURODEVELOPMENT
First consider all the physical reasons for sucking/swallow difficulties.
Work with your baby’s health care providers to find the best feeding schedule to not over tire them if they feeding difficulties but will also get them enough nutrients. When they are tired you will see more choking and gagging. Also for bottle fed infants adjust the nipple so that the flow allows the baby to get enough but not too fast.
Helping your baby to use a pacifier may also be helpful to train their muscles and help coordinate their sucking.
Swaddling during feeding may be a helpful tool in helping decrease other 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.
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 the suck/swallow difficulties with the help of 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.
Observe your baby’s suck/swallow/breathe to see if it is coordinated when they are feeding.
Recommended interventions:
Use a pacifier to help with learning to suck
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.
NURSING
It is important to determine the root cause of suck swallow difficulties. If you are unsure or they continue to have problems during feeding, you need to call your baby’s doctor’s office. You should request a referral to a speech/language therapist with experience with feeding training.
Swaddle with a pacifier to help your baby learn to suck. 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.
Monitor your baby carefully during feeding to make sure they don’t gag or choke. Also keep your baby in an upright position for at least 30 minutes after feeding.
OCCUPATIONAL THERAPY
Swaddle your baby during feeding. Swaddling helps to organize and calm your baby so that he/she can fully focus on suck/swallow and breathing. 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.
Use slow flow bottles to help your baby with their swallow difficulties.
Use a Pacifier to offer your baby a way to learn to coordinate their sucking.
An occupational therapist may be able to help you with some massages for around the mouth that may help the baby with coordinating their sucking.
SPEECH PATHOLOGY
It will help to teach your baby coordination by teaching them to use a pacifier. 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.
Keep the chin area dry and wipe up to help promote muscle development around the mouth.
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 Occupational Therapist who has experience in feeding training.