Question:  I am a mother to a baby who is 6.5 months old, corrected age.  He was born at 29 weeks gestational age.  Because of being on a high level of O2 support for a long period of time, being intubated several times, and experiencing reflux, he has had an aversion to liquids and was not able to learn how to suck on a bottle effectively.  A g-tube was placed before he left the NICU.  He is now fed exclusively through the g-tube, but his speech therapist and I are making progress on his oral acceptance of liquids and solids.  His reflux has been managed.  However, his oral mechanics still do not allow him to process more than .1 to .2 ml for each swallow.  He has marked tongue thrusting.

Regarding tools...  at this point we are making use of the Baby Grabber and are using a 1 ml syringe for liquid practice.  We have attempted to use several sippy cups without much success so far.  Could you suggest products that we could use for feeding practice, tongue placement/mechanics, and general oral work that will help us work towards g-tube independence?  

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I would recommend doing gum massage during his g-tube feedings, or having him bite/chew/mouth some chew tools.  You said you have a Baby Grabber that he enjoys, which would be great to use.  The proMini can also be used to stroke the sides of the tongue, stimulate the inside of the cheeks, and brush or tap the tongue.  The goal is to provide stimulation to the tongue, lips, cheeks, and gums as if he were eating while being fed via g-tube.

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In reference to his tongue thrust, ask your SLP to go over the difference between a suckle and a suck with you.  I cannot comment since I cannot actually see what he is doing.  However, all infants have a tongue thrust swallowing pattern which will eventually change as he grows older.

You may try to work on straw drinking with the guidance of your SLP.   Try cutting a regular straw in half or even smaller.  While holding your finger over one end, dip the other end in his formula or any stage 1 baby food that he enjoys.  Since he has a good strong suck, this may just work.   You can also use ARK's Bear Bottle to teach straw drinking.

It depends on the sippy cup, but some of them can help promote a tongue thrust.  The liquid comes out too fast inside the child's mouth and he/she uses compensatory tongue movements to manage the overflow.  The mouthpiece can also be too wide and large for the child's oral cavity size, again creating problems.  If you are going to try sippy cups again, I would recommend reading this post first to find an appropriate one.

Just a note on reflux - I have known parents to take their children off their medication without consulting the pediatrician.  They usually do this between the age of two and three because their child appears to be symptom free.  But then feeding issues begin.  So, please consult with his pediatrician first before doing so, and I know that you will.  You are an investigative parent, who only wants to do the best for your wonderful baby.

Please give me updates as to his progress.  If you have any other questions or concerns, please do not hesitate to contact me.

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All the best, 

Debbie

Debra C. Lowsky, MS, CCC-SLP

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