Oral aversion and encouragementBy: charlyn (1:58 PM 02/02/2011)
When my son was able to started oral feeding at 3 wks, the nurses and docs had us start him out on 1 ml and it increased to 5, then to 10. Eventually, it went all the way up to 65ml at every feeding (I can't remember how many times a day). The whole point was to get him off of the nasogastric tube. Then, he had water-loss stools, dehydration, and he just got really sick. Even though only 2-3 cm of his bowel was removed, he couldn't handle large amounts of milk. It was just passing through his system and he wasn't getting any nutrition. So since then it's been a roller coaster trying to get the right amount and giving him TPN to cover the rest. Anyway, since he got sick the first time we tried bottle-feeding him he's got oral aversion. Carsen is a year old now and on continuous feeds 24/7 (no bolus :p). He has reflux and hyper-sensitive gag reflex. He doesn't eat anything by mouth and swallows very little. Anything that gets to the back of his mouth he gags and more than likely throws up.
When we saw his feeding therapist for the first time a few wks ago, she said the only thing going for him was that he still liked putting things in his mouth and chewing/biting. For the parents out there who didn't get a chance to breastfeed or bottlefeed, skipping that and going straight to purees and thin liquids might be the way for you. That's what we're doing with my son. We are now just trying to encourage Carsen to discover/play with his food so eventually he'll start putting the food in his mouth and he'll taste it on his own. The idea is to have him enjoy putting yummy food in his mouth. If we force him to do it against his will he'll reject it completely and it will be harder later on. To help with the gag reflex giving him long objects (with supervision!) like spoons and biter biscuits should help Carsen get used to something further back in his mouth.
At 65 ml/hr on continuous feeds, bviously, Carsen doesn't know hunger yet. He won't know for a while because his GI doctor wants his weight to be in the 25th percentile before starting bolus feeds. He's come too far and we don't like taking too many risks, haha. So, until then, sitting Carsen with us during lunch and dinner is all we can do. Hopefully, over time, he'll be eating more than just a taste.