To Medical Personnel

Learn About Wonders Of Breastmilk

Nursing your baby on breastmilk is not just good for the baby, it's also great for the mother. How is breastmilk produced? What components in breastmilk are good for the baby, and why?...

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Hints For Continuing To Breastfeed

For better breastfeeding, here are some helpful hints....

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What Should I Do? (Mother Edition)

“I don’t think I have enough breastmilk…” “I’d like to go back to work.” We’ll answer these and others questions about the mother’s body and lifestyle....

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What Should I Do? (Baby Edition)

“My baby doesn’t seem to be gaining enough weight…” “My baby bites my nipples…” We’ll answer these and other questions about the baby’s body and condition....

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To First-Time Father

When your first child is born, your wife will be filled with anxiety about herself and about your baby....

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To Medical Personnel

This information is about the various conditions that prevent babies from nursing directly from the breast. We introduce various products for low-birth-weight babies, babies with cleft palates, and baby...

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Ingestion disorders and dysphagia during the neonatal period can be regarded as

1. Sucking and swallowing disorders. Patients need to be assessed with the following perspectives:

1) Nutrition intake and growth

2) Development of sucking and swallowing functions

3) Underlying disorders.

Ingestion disorders and dysphagia are frequently observed in neonates with congenital disorders. If underlying disorders are treatable, the medical intervention would be prior to them. Because babies are undergoing development of ingestion and swallowing function, age factor should be considered. It is important to understand which process is disturbed.

Since babies are on the way of development, the symptoms would change drastically along with the neurorogical development. Moreover, the prognosis varies with the underlying disorders. This should be considered together with health condition.

Chart 1 Development of Ingestive Abilities in Infants

Age 0-5 months 5-6 months  7-8 months 9-11 months
Tongue movement Peristaltic-like   Front to back Up and down Left and right
Lips and Mouth Half-open/Tongue protruding Lips closed Left/right flex at the same time Left/right flex alternately
Food Liquid→ Mashed→ Soft solids/Shredded→ Bite-size/Solid

The table combined with etiology and dysfunction, is shown below.

1.Immaturity Low birth weight infant Preterm infant These conditions are not real "problems" but to be considered. Because of the prematurity of coordination between sucking, swallowing and respiration, they would have some risk of aspiration.
2.Anatomical and structural problems Cleft lip
Cleft palate
Micrognathia
Structural defect of lips, pharynx, larynx and esophagus could cause Sucking and swallowing disorders. That include congenital conditions (cleft lips/palate, micrognathia) and acquired illness such as tumors.
3.Problems of the central and peripheral nervous system, and muscles Cerebral Palsy, Hypoxic-ischemic encephalopathy, Myotonic dystrophy, Werdnig-Hoffmann disease Dysfunctions of the cerebrum, brainstem, cerebellum, spinal cord, peripheral nervous and muscles could cause the impairment of the coordination between sucking, swallowing and breathing. Also those dysfunctions could involve excessive increase and decrease in involuntary and voluntary muscle movement. All of these problems could lead Sucking and swallowing disorders.
4.Dysfunction of pharynx and esophagus Laryngomalacia Esophageal achalasia Dysfunctions in the pharyngeal and esophageal motor abilities could cause the difficulties of the coordinated movements.
5.Deterioration of general condition Congenital heart disease
Respiratory disease
Systemic infection
Deterioration of the general health status, caused by various diseases leads to Sucking and swallowing disorders.
Even nasal obstruction could cause respiratory disturbance and sucking and swallowing disorders.
6.Psychological problems Tubal feeding dependence Problems of appetite and mental issues such as anorexia, dependence of gavage feeding with refusal of oral feeding, and refusal of infant formula would cause sucking and swallowing difficulties.
7.Others Stomatitis
Dry mouth
Painful lesion such as stomatitis could cause Sucking and swallowing disorders.
Dryness of mouth due to fever or the side effects of medications could cause Sucking and swallowing disorders.

1) Sucking and swallowing for low birth weight and preterm babies: Summary of symptoms

  • Low sucking pressure and unstable sucking and swallowing
  • Intermittent sucking
  • High risk of aspiration because of immature coordination between swallowing and breathing movements.
Ways of treatment:
  • Because the coordination of sucking, swallowing and breathing movements would be matured around 35 weeks of gestational age, it is important to nurse the babies carefully.
  • Practice the babies to latch on their own mothers' nipples with kangaroo care
  • Give the babies gentle massages outside and inside of their mouths to become habituated to the stimulus of sucking and swallowing.
  • Press gently the babies cheeks on the both sides to practice them to generate negative pressure in their oral cavity.

2) Sucking and swallowing for babies with a cleft lip/cleft palate: Summary of symptoms

  • Difficulties of sucking because of disfunctions of generating negative pressure and compressing nipple in the oral cavity
  • Risk of backward flow of breastmilk or formula through the nasal cavity of babies
  • Risk of aerophagia
  • Shortage of milk intake with taking excessive time of sucking
Ways of treatment:
  • Breastfeed or bottle-feed with much care of aspiration and backward flow of milk through nasal cavity
  • Take appropriate position during breastfeeding or bottle-feeding
  • For babies with cleft lips, make sure of shielding lips firmly while sucking
  • For babies with cleft palate, it would be effective to use an artificial palate (such as Hotz-type Orthopedic Plate)

3) Sucking and swallowing for babies with micrognathia: Summary of symptoms

  • A smaller jaw, receding mandible, or depression of the root of the tongue would block the respiratory path, causing sucking and swallowing disorders.
  • Robin Sequence is characterized by a small or receding mandible, depression of the root of the tongue, cleft palate, and obstruction of airway. Airway obstruction or cleft palate could affect sucking ability of babies because of the difficulty in generating negative pressure within the oral cavity.
  • Also the babies with Robin Sequencde usually have an U-shaped cleft palate. As a result, backward flow of breastmilk and formula enters the nasal cavity of the babies.
Ways of treatment:
  • Because the babies with micrognathia have respiratory disorders frequently, it is essential to check if the airway is blocked while nursing.
  • For more effective nursing, it could be recommendable to hold the baby on the vertical position, or pronely if needed, so that the airway could not be obstructed or the tongue of the baby could not recede.
  • In the case that the baby with micrognathia would also have a cleft palate, it is necessary to take care of the cleft palate itself.

Biography

1978 Graduated from Showa University Medical School
1978 Reserch Assistant of Showa University Medical School, Laboratory of Pediatrics
1980 Kanto Rosai Hospital, Pediatric Department
1981 Kanagawa Children's Medical Center, Department of Neurology
1983 Reserch Assistant of Showa University Medical School, Laboratory of Pediatrics
1988 Assistant Professor, Showa University Medical School, Laboratory of Pediatrics
1997 Department Manager, Sempos Tokyo Takanawa Hospital, Pediatric Department
2003 Director of Kita Ryoiku Medical Center, Jonan Branch Hospital
2005 Associate Professor, Showa University Medical School, Laboratory of Pediatrics
2006 Professor, Showa University Medical School, Laboratory of Pediatrics

Publications

Tatsuno, Mukai (Ed.) (2006) Rehabilitation for Infants with Feeding and Swallowing Difficulties, Ishiyaku Pub, Inc.