Question
I have a homehealth patient who is a premature baby just home from the hospital after 4 months whose actual age is 1 month. G-tube is in place, but consumes 2 oz of formula on average per feeding. One of my goals is to increase formula PO, but I'm having
Answer
I can make a few suggestions, but before you implement any of them, you should check with the patient's pediatrician that it is o.k.
If fatigue is truly the issue, then perhaps trying to p.o. at every feeding may be too tiring. It might be worth only trying p.o at every other feeding or when the baby is truly awake and hungry and trying to optimize the amount taken then and allowing rest (and a G-tube feeding) through a few feeds. The baby sounds like it is trying its best to coordinate the S-S-B triad by limiting the number of sucks and then pausing to coordinate swallow and breathe. That can be tiring. It is also best to limit the length of a p.o. trial to about 30 minutes.
A few other things to look at: how is the lip seal/strength? Does the baby need some support to decrease jaw excursion? AND what is the tongue doing? Is the nipple truly on top of the tongue? Is the tongue active in stripping the nipple, which prepares the system for the swallow?
It is difficult to assess what the actual problem is without seeing what the patient is doing, but try to consider all the factors that go into swallow-energy level, alertness, motor skills, sensory responses, and overall medical status-to name a few.
Mary E. Warburton, M.A., CCC-SLP has been a speech-language pathologist for 9 years. She is the Lead Speech-Language Pathologist at St. Louis Children's Hospital, specializing in Pediatric Feeding and Swallowing, NICU, and Lung Transplant patients. She resides in St. Louis, with her husband and 2 young sons. She can be reached at maryew@bjc.org.