Infant Feeding (Part 1)

Posted on February 16th, 2013 by Denise | No Comments

Infant Feeding (Part 1)

By

Denise Koonce OTR

I ended the last infant formula blog with a list of questions that, when answered, are helpful in “putting the pieces together” in regards to infant feeding.   These questions, and therefore their answers, will begin to create a “picture” of the child’s feeding, much like a jigsaw puzzle coming together.  It is one way of analyzing data to then create a treatment plan. 

What is the specific formula the infant is on and why?   It is important to know what type of formula is being used and why it was chosen.  Ask the parent if other formulas were tried while in the hospital and what were the results.  For the populations we treat, such as infants born prematurely and it’s accompanying complications, or patient’s with a cardiac, respiratory, renal, neurological or gastrointestinal diagnosis, the medical team may try two or more formulas before finding one that best meets the infant’s needs.  The medical team may change the formula when the infant exhibits negative reactions such as bloody stools, diarrhea, or vomiting or adjust the kcal/per oz of a formula if the infant is not gaining enough weight to meet their needs.   The medical team, within a hospital is able to administer higher caloric value formulas than what is available to the general public, because they are able to monitor the child through constant supervision and lab results.  If an infant has been receiving formula at 24–26 kcal/per oz they may be discharged with a lesser kcal/per oz recommendation.  Once you know which formula has been recommended, then note whether it is cow’s milk, soy, partially hydrolysate, or amino acid based formula. 

Who prescribed or recommended the formula?   You will need to know which member of the medical team recommended or prescribed the formula so if there is a concern or as feeding progression continues you will know whom to contact.  It is wise to contact that individual early on in treatment and establish a report so when you need that individual’s input they will know who you are and your role in the child’s feeding.   

Is the formula in powder or liquid form?   Finding out if it is powder or liquid will then lend you the opportunity to ask how they are mixing it, when they are mixing it, and make sure they are mixing it appropriately.  When mixing the powdered formula and concentrate with water, bubbles are produced.  If powdered formula is used do they make a large batch or an individual serving and do they allow the bubbles to settle first before feeding.  If the child is already having issues with reflux or “colic” or is very gassy it is beneficial to allow the bubbles to subside as much as possible without a separation of powder from the liquid, prior to feeding the infant the bottle. 

What temperature is the formula being served?  Most formula instructions say to use cool previously boiled water to mix with the formula and serve at cool or room temperature.  Many parents choose to serve the formula warmed.  Either is fine but it is good to note that sometimes the temperature can make a difference to the infant.  I have found a small percentage of infants, due to sensory dysfunction; will improve their intake if the formula’s serving temperature was something other than what they had been given in the past. 

Less important but still pertinent is what bottle and nipple are being used?  Bottles and nipples are a basic tool used to provide nutrition to an infant, but they are not the primary focus of therapy for infants with a feeding disorder.  There are times when changing the bottle or nipple is conducive to achieving better results but most of the time improvement in withdrawing the liquid from the bottle occurs with improved oral motor control.  There are numerous options a parent has to choose from when it comes to bottles and nipples.  For example the market produces at least 9 different styles of nipples.  They are natural shaped, orthodontic, latex, silicone, traditional, anti-vacuum, multi-flow, and slotted multi-flow nipples.  These are only styles, not the actual nipple options, you have to select from the shelves.  Each manufacturer, which there is over a dozen, will have their version of each of these styles.  That calculation can leave you with almost 100 choices in nipples alone.  That is a lot of options and we didn’t even discuss the bottle choices that go with the nipples.  My point is there are numerous options and variables for bottles and nipples and choosing them can become very overwhelming to a parent who has a child with a feeding disorder.  It is usually best to focus on the infant’s oral motor control first.  As treatment progresses, continue to evaluate if changing the nipple/bottle combination would benefit the infant.  Depending on when you begin treating the infant it is helpful to ask the parent if they have already tried other bottles or nipples prior to the current ones they are using and why did they change. 

This blog (Part 1) only begins to address the explanation or answers behind the questions that are helpful when evaluating a patient with feeding difficulties.  I will continue to provide the answers to the remaining questions in the next couple of blogs.  If you have questions regarding feeding or have additional information to share about your feeding experiences as a therapist, please send us a comment.

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