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Swallowing dysphagia as a cause of rejection of solid foods

September 14, 2011

Interesting updates on our recent Ask B & K case regarding the toddler who refused solids.  Ameera, the Egyptian IBCLC who wrote us about this case communicated the surprising news that the mother weaned the baby and the baby immediately began accepting solids.  This is a very counter-intuitive result, but in the interest of intellectual honesty, we feel obligated to report the outcome.

We also received a very interesting response from a mother with a similar problem whose baby was eventually diagnosed with swallowing dysphagia.  Read her story by scrolling down to the bottom of our response to Ameera.  Please send us your thoughts on these cases.

Swallowing dysphagia as a cause of rejection of solid foods

A mother wrote us in response to Meera’s question.  Her comments are quite interesting, and Kay and I thought we would share them because they represent another organic reason why a child might reject solids.  Shannon’s persistence in seeking a reason for her child’s delayed reaction to a normal developmental milestone shows how difficult it can be to find answers and how often it is necessary to seek second and even third opinions from care providers.

Shannon writes:

I want to share another possible reason why the baby in Egypt will not accept solids.  When my son, Finn, was 6 months old, I was concerned that he refused to take any solids.  He accepted food, but as soon as it touched the back of his mouth he gagged.  Pureed food could be thick or thin, but it always elicited a gag response.  We tried several varieties of fruits, vegetables, and cereals with no success.  Even juice, water or expressed breast milk fed from a spoon made Finn gag.

Some of my LLL friends told me not to worry, sharing that their babies refused solids until 10 months or 12 months. But what was so overwhelming and concerning to me was that Finn was  also unable to take a bottle or cup.   He had the same gag reaction to anything in his mouth, so eventually he began refusing the bottle or cup.  I recall he was able to take the bottle a few times in his first month, but from 2 to 6 months was unable to. This did not seem normal to me.

His breastfeeding behavior also concerned me.  Finn often broke suction once my milk let down.  I could hear him breaking suction as well as feel it. Even at 8 months old he would often come off the breast gagging, unable to handle a fast milk flow rate.  Finn began sleeping 4-5 hours at a stretch at night around 3 months old, giving me some rest, but when he was 7 months old he went back to nursing every 2-3 hours at night. The pediatrician and I thought this was because he was hungry.  We began doing weekly weight checks and he was staying in his curve, I think due to the frequency of his night feeds.

I teach classes in the evening once a week and am away from him for 4 1/2 hours.  My husband had to bring the baby to me before class, at the class break, and at the end of class to nurse because his feeding difficulty made it impossible for others to care for Finn.

The pediatrician looked in his mouth and noticed a bifid uvula and suggested we schedule an appointment with a pediatric ENT to rule out a submucous cleft of the palate.   It took a month to get the appointment.  In the mean time I contacted Early Intervention to see if Finn would qualify for services.

A Speech Therapist came out to perform an evaluation. After screening Finn for delays in all the developmental areas she did not observe enough delays for him to qualify for therapy, even though at 9 months, he could not take a cup or bottle, eat any solid foods, or sleep for more than 3 hours at a time.

 

The speech therapist told me to just let him “cry it out” at night.  She advised also my husband to let Finn cry because at 9 months he should be able to go 4 1/2 hours without eating and that the crying was a behavior issue not a hunger issue.  This advice disturbed me because although I know my husband is not at risk for shaking a baby, the statistics show that men who are left with crying babies are the most likely to shake them.  Her advice did not seem sound or humane to us.

We finally saw the ENT and he made a diagnosis of dysphasia and he ordered a barium swallow study.  Once we got the diagnosis, we became eligible for  Early Intervention services in our home. The Occupational Therapist (OT) helped us schedule the swallow study and was there to help us understand the results.  We learned that at 10 months old, Finn had the swallowing capability of a 3-month-old.  Along with the slight structural abnormality, his main problem was low tone.  The OT specialized in a technique called Vital Stimulation Therapy that uses externally applied low-current electric stimulation to the neck and face.  She told us that she had seen this help many infants improve their breastfeeding and solid feeding abilities so I was eager to try it.  (Their website http://www.vitalstim.com/ describes it as an “FDA approved therapy for dysphagia.”)

The OT attached electrodes to Finn’s neck and put ace bandage around to hold it on.  She started out at a low frequency and then after 10 minutes increased.  He tried to pull the wires off a few times, but got used to it quickly.  He nursed for the first 5 minutes, then the rest of the 30 minutes he sat on my lap and played as she increased the intensity.  A few days later, he was able to take a few tiny sips of juice from a small cup for the first time without gagging.  A week later he was able to take a few tiny tastes of yogurt off a baby spoon!  This was a milestone for Finn, but to me it meant freedom!

Finn only needed 3 more sessions of vital stimulation to achieve swallows from the sippy cup and move onto other foods like french fries. When Finn was 12 months old,  the OT decreased the therapy from weekly to twice a month.  At 16 months, Finn saw the OT only once a month.  At 21 months, we had our final OT session.  Finn is now 28 months old and still mostly nurses, only eats a few bites of food when he is around me, but when I am working and away he eats more.  At his last appointment he was up to the 47 percentile from 30th just three months before.

I hope sharing my story will help others consider swallowing dysphagia as a possible reason for solid food refusal.

Shannon.

 

 

 

Wilson-Clay/Hoover Poster Prize

July 28, 2011

Congratulations to this year’s winners of the Wilson-Clay/Hoover Poster Prize.  The poster that won the award this year was submitted by Pamela Hendrix, Susan Welke, Kerry Foligno, Angelina Rodriguez, “The Lived Experience of Lactation Following Bariatric Surgery.”

2011 ILCA Scholarship Winners

Shown (from left to right), are Syreeta, a WIC Peer Counselor from Virginia, Kay Hoover, and Victoria, an IBCLC from Ukraine, winners of the Wilson-Clay/Hoover ILCA Conference Scholarship.  Also shown (far right) is Joy Heads, a proud new ILCA Board member. The Wilson-Clay/Hoover Conference Scholarship was developed as a mentoring opportunity to assist new and aspiring LCs to attend the ILCA conference for the first time.  Barbara and Kay hope that the exceptional international environment and the educational stimulation of the conference will inspire these new members of our profession to take some of that excitement back to their own practices.

Photo Identification Quizzes helping students around the world prepare for the up-coming IBLCE Certifying Exam

July 12, 2011

In just under a month, over 200 students preparing for the LC certification quiz have signed onto our website to take one of our new multiple choice clinical photo identification quizzes.  Students from all over the world, including Singapore, Greece, Poland, Canada, Australia, have emailed to say thanks for the opportunity to practice for this challenging portion of the IBLCE exam.  Kay and Barbara want to wish all the exam candidates good luck, and to thank everyone on the positive feedback.  There are great reviews of our quizzes from USLCA and The Journal of Clinical Lactation.

Singer Candice Jones and Barbara Wilson-Clay at the Cobb and Douglas Co WIC Conference in Georgia

July 1, 2011

Candice, one of the  great WIC peer counselors from the Atlanta area, presented the luncheon entertainment for the conference at which Barbara presented a day-long clinical training workshop.  What a fun group!

Kay Hoover’s poster on the use of radio-contrast agents and breastfeeding appears in the June 2011 issue of the Journal of Clinical Lactation

June 2, 2011

Anne Charest, IBCLC, and Ghislaine Reid, IBCLC, two lactation consultants from Quebec, Canada, generously translated the poster into French.  Anne and Ghislaine have agreed to let us share their translation with other French speaking lactation consultants around the world.  Both the English and French versions of Kay’s poster may be freely reproduced and shared.  Thanks, Anne and Ghislaine for expanding the usefulness of this important tool.

Radio-Contrast Materials and Breastfeeding Poster

Lactation Photo Identification Quiz Series Review by Kathleen Marinelli, MD, IBCLC, RLC, FABM

May 31, 2011

BreastfeedingMaterials.com Training
Lactation Photo Identification Quiz Series; Quizzes 1 and 2
Barbara Wilson-Clay and Kay Hoover, © 2010 BreastfeedingMaterials.com
The Lactation Photo Identification Quiz Series is a new addition to Barbara Wilson-Clay and Kay Hoover’s collection of visual teaching and learning aids. It can be used by would-be lactation consultants or healthcare professionals who desire to improve clinical lactation assessment skills in a more interactive way than by reading words in a textbook, and by lactation consultants preparing to take or re-take the credentialing exam. The series consists of two separate quizzes, each with 50 lactation-related photographs and an accompanying multiple-choice question.
Read the rest of this entry »

Peer Review for Photo Identification Quizzes

May 11, 2011

We’re proud to have had ILCA write a positive review about our new product.

Originally Published by International Lactation Consultant Association

The training website is a resource for lactation consultant exam candidates to practice the photo identification component of the IBLCE exam. It is also intended to assist people in a clinical setting to improve their lactation knowledge.

The series is divided into two parts, each with a separate URL. The first page gives clear instructions on how to complete the quiz. It gives the layout of the quiz with the number of questions given and the required time to complete. Each quiz is set out as multiple-choice questions with only one question visible at a time. On completion, the student is given a grade.

There are four choices for each question. Upon pressing the submit button, a box appears and informs the user of whether the question was answered correctly, and where incorrect it gives the correct answer. One noteworthy feature is depth of the information about the correct answer, making it most useful in reinforcing the choice of the correct answer or in recalling forgotten knowledge.

Each question is set out clearly with big font that is easy to read. The background colours are soft, which helps prevent eyestrain. The information is clearly referenced with citations from a wide variety of reputed journals and textbooks (with page numbers), which make it extremely effective, should one wish to read further. The time allocated is sufficient and should not leave you feeling rushed. The overall content is stimulating, leaving the user wanting for more. Should one choose to redo the quizzes, however, the same questions are presented in random order.

A suggestion for a future release is to divide the questions into topics, for example latching or baby appearance, so the test taker can receive a grade per section. Overall, the quiz series is enjoyable as well as conducive to learning. It covers a broad range of topics and is definitely a good tool to improve breastfeeding knowledge.

Laura Sayce, BSc
Bromhof, Randburg, South Africa

© International Lactation Consultant Association

The “3 Kathleens” Lecture in Bilbao, Spain

November 30, 2010

Kathleen Hoover, M.Ed, IBCLC, FILCA (left) Kathleen Marinelli, MD, IBCLC, FABM, FAAP, and Kathleen Kendall-Tackett, PhD, IBCLC (right) gave talks at the 2010 La Leche League of the Basque Country IV Simposio Internacional sobre Lactancia Materna  November 15-16.  Participants and other presenters came from Spain, Greece, and Canada, and the US.

Dr. Marinelli (center) supervises publication of all the on-line lactation management protocols for the Academy of Breastfeeding Medicine (www.abm.org).  She spoke about lactation management of  babies with cardiac defects and low motor tone.  Dr. Kendall-Tackett presented her research on postpartum depression.  Our own Kathleen, Kay Hoover, addressed issues such as:  When Baby Won’t Latch, Managing Nipple Pain, and Helping the Mother of Multiples.

Austin Mothers Milk Bank In The Press

November 29, 2010

Austin Mothers Milk bank got a great write-up in the Austin American Statesman Thanksgiving weekend and ran some photos of their  wonderful new facility.  Take a look!

View Austin American Statesman article Austin Mother’s Milk Bank helps nourish premature babies.

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