Wednesday, March 24, 2010

Dysphagia 1 feeding

Well, not really, but a dysphagia 1 diet consists of pureed foods and that's exactly what early baby foods are: puree.

So, after he took the Praxis, Jon came back for some hang time with the nephews. I got to take Luke for the non-existent whoopie pies and he got to feed Zac.

The last time Jon fed a baby, he was in the NICU at St. Bernardine's, feeding preemies from a bottle. This is not as easy as it sounds. You would think, "Hey, feeding a baby; no big deal. And, hey, feeding a really small baby; even less of a big deal. Because the baby is, you know, smaller. And probably less feisty." But no.

Bottle feeding a preemie involves teaching the baby how to swallow. Early preemies are born before the swallow reflex has developed, which is why they are tube-fed until they are old enough to learn to swallow. Plus, preemies are already medically-fragile and have compromised respiratory systems. One of the easiest ways to really mess with a respiratory system is to allow someone with any kind of swallowing disorder (including not yet knowing how to swallow) to eat. If you don't swallow correctly (and this involves timing and laryngeal elevation and coordination with the respiratory system and the ability to cough to clear if all else fails), then you can aspirate and end up with food in the lungs. Let me assure you, this is not good.

Preemies who don't know how to swallow have to be taught. You have to stroke the palate to get the tongue moving. You have to stroke the cheek to encourage them to root. You have to position them correctly (generally, in front of you, head in your hand, body on your forearm, at a steep upward angle). You have to check the monitors to make sure the O2 sats don't fall to low. Preemies will often find feeding so new and challenging that they, well, for lack of a better term, forget to breathe!

After you feed them, you must burp them. They must burp! Upright! This is crucial because, again, they don't really know how to swallow and if they burp in a supine position, they are likely to aspirate. After all that, you'll probably have to change their diaper. Jon changed his first diapers in the NICU (talk about a pressure situation but the nurses and his supervisor all found it very amusing).

Feeding preemies is definitely not for the faint of heart. But feeding Zac? Piece of cake. The kid loves to eat. And he knows how to swallow. The worst thing that can happen with this little guy is that he will start to get fussy if the spoon arrives at his lips too slowly. He should be working his way up to a dysphagia 2 diet (minced) before we know it.

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