Hi Lori,

I have a 7 months old client who is a breast feeder. When trying to give her new things like applesauce, yogurt, etc. She makes the bolus but she doesn't swallow. What can I do for her to swallow, besides achieving lip closure? Specifically for swallowing. I hope you can help me. Thank you.

Rosy

Hi Rosy,

I wish it was as easy as just making recommendations for treatment ... but your treatment needs to be based upon assessment. You need to look at this child's medical issues (does this baby have respiratory issues, gut issues, allergies, etc? What is the primary diagnosis?), tone, posture and alignment issues (what you see in the body is what you get in the mouth), sensory system (is this a baby who has modulation, regulation or sensory discrimination issues?), oral structures (have you looked at the shape of the palate, the labial frenum, lingual frenulum, etc?) and then do a task analysis of oral sensory motor skills (you can task analyze any motor skill) to support safe nutritive feeding. Once you can target WHY this child is having difficulty managing purees, it will be appropriate to plan a program or to ask for suggestions for program planning. The two-day sensory motor class or the sensory motor feeding book may be helpful. Best,

Lori Overland, MS, CCC-SLP, C/NDT

Dear Lori,

I attended the Sensory Feeding Course in England in June, and would like to thank you for a full two days of professional input.  Before I left Manchester, I had already thought of how I was going to utilize some of the techniques in my therapy sessions.

You had mentioned that you would not mind answering questions, so I hope you do not mind me taking advantage of the very generous offer.

I have my first appointment to see a 4 month old boy with feeding problems next week.  Mom reports that he breast fed nicely (after an initial period of latching difficulty, and the need to suck using a nipple shield). After 1 week, baby got floppy, stopped feeding, and was taken to hospital, where he stayed for a few weeks. He is currently being fed through a nasal feed tube.  Although he is reported to have a strong suck, he does not suck on breast for long. Bottle feeding has the same results.  This child has had extensive genetic testing, endoscopy (up to larynx), videofluroscopy, and EMG--all without any abnormal findings. He is scheduled for an endoscopy to investigate the esophagus.  He has reflux, and I was told that milk came through the nose.  The ENT did not find any sub-cutaneous cleft, nor velo-pharyngeal insufficiency.  He will also have an MRI.  The current medical opinion seems to indicate problems with swallowing.   All this information was received by phone. I have not seen any reports, as yet.

My goal for the session (aside from meeting and assessing the child), is to show mom the oral and sensory-motor stimulation techniques and massages (as well as hand, foot and body massages).  I also would like to introduce some pre-feeding activities, to try to prevent, or, at least minimize oral sensitivity and aversion to food taken orally.

Question: With a dry spoon (Beckman E-Z feeder), shall I introduce spoon feeding with a front feed, or side feed technique? I am inclined to do both, as they involve different oral motor movements.  However, I do not want to instill incorrect feeding behaviors.  (This is the first time that I am working with an infant).

I would like to thank you in advance for your input.

Best regards,