Monday, December 15, 2008

Exclusively Nursing... Forever...?

I really need your advice on infant feeding. Here's the situation:

Angelina (7.5 months) appears to have very active gag reflex plus some poor coordination over her tongue. I never realized just how necessary the tongue is for swallowing until I watch her try to move pureed foods back into her mouth without success. The good news is she nurses absolutely wonderfully! And she's the right weight and height, above average maybe.

So, I put very watery pureed food into her mouth as the pediatrician recommended, and it sits there in her mouth as her tongue tries to work with it. A lot of it comes back out, and she often gags on the food that makes it all the way back to her throat.

She has better luck with Cheerios... maybe because they're harder and small, she seems to be able to feel each individual one in her mouth and work it back and down the hatch, albeit slowly.

The advice I've received from our pediatrician and friends is to just keep practicing. So that's what we're doing.

But meanwhile, I'm wondering:

(1) Does anyone know what I'm describing, this uncoordinated tongue thing? Is there anything else I can be doing to help her work it out, and to work on the gagging as well?
(2) Is it OK for a 7.5 month old to be receiving 99.9% of her calories from breastmilk still? The few Cheerios she manages to consume don't account for many calories at all, but I do give her a vitamin supplement when I remember. I'm hesitant to wean her from night nursing because I think she needs those extra calories from night feedings to make up for no other food during the day.
(3) Is it possible that we can skip pureed foods altogether and do more solid foods since she seems to work with them better? And do you have other recommendations on very small finger foods that a baby her age could swallow--basically, same effect as Cheerios but something different?

She's the most lovely, wonderful baby... she's happy all the time, and the feeding trials don't bother her either. She just smiles and keeps trying!

So, Doc Alex and any other seasoned moms... I'd so appreciate your help! Our next pediatric checkup is at 9 months, and I'd love to have some improvement by then.

22 comments:

momof4 said...

Dear Juris Mater,

here are my thoughts, i will answer your questions according to #

1.I have seen this uncoordinated tongue thing that you are describing. i work in the dental field as a hygienist. If it is a true swallowing problem, you can have a swallowing study preformed. there are teams of practitioners at hospitals that treat only swallowing difficulties. There are specific swallowing and sucking exercices that can be taught to you by these professionals if she does in fact have a swallowing problem....but with that said i am not certain your daughter has swallowing issues, she may just not be ready for solids yet, so here are my other thoughts...

2.my oldest daughter, now 7, exclusively breastfeed until she was 13 months old...i introduced solids many times, but she refused everything and spit out everything. i tried several times until she decided she was ready for table food...and that happened at 13 months old. she was gaining weight appropriately and there was never a concern that she was undernourished. i believe you are wise to continue the night time nursings, my daughter coslept with us, so she was nursing at night, i am sure that the night nursing though it was little did contribute to her calorie intake.

3. it is absolutely possible to skip pureed foods. i have done this with all 3 of my oldest children, the baby is only 4 months, so we have not started solids with him yet.

if your gut is telling you that there is a sucking/swallowing issue here, i would recommend seeing professionals. But if your daughter is trying to "nurse" from the spoon or sucking the pureed food like she is trying to "nurse" it, i would be inclined to say she is just not ready for solids and try again in another month or so to introduce solids. i know it can seem scary that your child is only receiving breast milk, but believe me if she is gaining appropriately and happy, she is fine. my daughter at 7 is in the 50 percentile and doing well. hope this helps, keep us posted!

margaretjdmom said...

My question is has she indicated an interest in solid foods (i.e. grabbing spoons, food off plates etc?) because she sounds more like a smaller baby who's just not that into the stuff. The gagging, the tounge thrust etc. just sounds like she's not ready in a sense. She certainly doesn't seem bitter she's not getting the food. Have you ever seen the babies that lunge at the stuff? They have an intense desire for it! Maybe she just doesn't like the consistency!

I would say go for the solid stuff if she's got the pincer grasp down....I assume she does if she's eating cheerios, but maybe you are just placing them in her mouth. I would hold off on the solid type foods until they can self-feed.

I can personally attest to many friends who still nurse a ton at 7.5 months with few solids mostly because the baby just wasn't that into it.

I started skipping the pureed foods with my younger two who were big and healthy (my first never nursed well and was a runt of sorts- so he really needed the extra calories!) Anyway, with the younger two we just moved to solids. Rip avocados and bannanas in little pieces were a big hit. I would cook peas and then de-husk them with my fingers (the shells are chokey) and smush them up a bit and place them on the plate- with a fork of course!! They loved cheerios/ teething biscuits etc, but those really have zippo nutritional value.

You can start meats at 8 months and I would give my kids ground beef or turkey and little teeny pieces of shredded chicken.

I know some people hate Dr. Sears, but I think he's got good advice on feeding and he talks about a lot of these food issues on askdrsears.com- check out http://askdrsears.com/html/3/T030600.asp for starters.

Hope that's helpful. I know what you mean about not cutting out nighttime feedings- I remember feeling like my kids still needed that extra meal or two as they transitioned to solids. That's ok though- besides, an added bonus of nighttime feedings (if you could actually call frequent night waking a bonus) is often a delayed onset of fertility. I think I read in some parenting book by Dr.Sears that a mother who is blessed with a baby who sleeps through the night is usually blessed soon after with another baby! HOpe I didn't just scandalize anyone! ; )

Thanks for doing this blog...it is fun to read, and since my husband is deployed and we recently moved to a new area, I can really use the distraction!

Anonymous said...

Gerber makes "puffs" which they call a first food. They are better at amusing babies while others eat than actually getting calories into the child, and like most Gerber food, they contain common allergans many people recommend babies avoid until older. But they dissolve easily and so are unlikely to choke a baby.

Whole foods sells bags of brown rice cereal. Only ingredient: brown rice. Slightly bigger than a rice krispy, they may be too small for the baby to pick up. But they also look too small to choke on.

There are Cheerio-like cereals without wheat (Cheerios has it) for people who want to delay that until 8 mo, or whatever the current recommendation is.

My 7.5 mo isn't eating any food from a spoon this week, apparently because of his runny nose. He's only ever had a couple of tablespoons (or less) in a day, so I'm not too worried.

Marie

Right Said Red said...

JM,

You are describing Gus--he did the exact same thing!

Gus didn't take to solids until 10 months of age. He still isn't a great solids eater, but we are working on it. If she is gaining weight and nurses well, try not to stress too much about it.

In our case, Gus just wasn't ready for solids until an older age. Our pediatrician thought he was swallowing fine (while nursing), but needed more time to really take to solid foods. He suggested that I quit altogether with the solids until Gus was older, 8 or 9 months. Every couple of weeks I would reintroduce solids, and he would gag and spit them out. Around 10 months he finally started swallowing very pure foods well. He now can pick up finger foods, and swallow things with small chunks (he is almost 1).

I didn't drop his night feeding until about 2 weeks ago--because I thought he needed the extra calories.

The best advice I can give to you is DON'T STRESS or put her on a time-line. So long as she is nursing well, she really doesn't need solids until later. Every baby is ready for solid foods at a different time, and so long as they are swallowing some solids by 1 year of age--no stress.

Good luck!

Gabrielle said...

Our 15 month old just had no interest in food until he could feed himself - aside from occasional yogurt or applesauce. The advice I received was similar - that at that stage solids are for "familiarity". I also thought night nursing was giving him valuable calories so I didn't think about night weaning...

Mary Alice said...

Leo is a great eater, but he goes through phases of rejecting the spoon for a few days, so I have been working on trying to find finger foods other than cheerios. One thing he likes is diced sweet potato, I just microwave one so that it is soft and cut it into tiny cubes.

I do think the others are correct in saying that this may be more of a readiness issue, though. The tough part is the burden on you as you will have to continue to meet her calorie needs over the next few months. I think that Red had to institute a "second dinner" for herself at some point to keep her supply up, this might be an upside!

Anne said...

i am no dr. in fact i'm not even a very experienced mom. but our son exclusively breastfed until he was 8 mos old and he's fine! so no worries!! :o) concerning that anyway!

Kat said...

JM, both of my kids weren't very interested in pureed foods, but it sounds like with Angelina that it is more of a readiness issue than an interest issue. She is so good-natured that it's probably hard to tell whether she likes the pureed food or not, but it sounds like she just needs a little more time to get the coordination of swallowing down.

Just to calm your fears, Maria is almost 14 months and we go through periods where she's only interested in nursing for a few days. Usually this is when she is teething (like now) or feeling sick, and it's nice to know that she is still getting good nutrition even when she refuses other foods.

On the flip side, I would like to know that Maria would be okay if for some reason I wasn't able to nurse her, i.e. a hospitalization for me or some other abrupt circumstance. So, I am trying to get her used to drinking milk from a cup or sippy cup, but she's not terribly interested at this point.

Alex said...

I agree with the experienced mothers on this one. Each baby develops mature swallowing reflexes and tongue thrust on her own timeline and since Angelina does not seem to be upset by the solid food trials, I suggest continuing to give solids a shot every so often until you find that she is able and ready for them. Aside from the behavioural benefits (i.e. familiarizing your baby) of starting solids at the recommended 4-6 months, getting more iron into your baby's diet is important at this point, so be it through the vitamins or something non-Cheerio, think iron when you can.

Also, JM, do I remember you saying at some point that Angelina has reflux problems? There is a clinically observed correlation between reflux and problems with the infant swallow reflex, so that could have something to do with it. If you are not already treating her with an anti-reflux med, that could help her swallowing problems.

Anonymous in NY said...

I nursed forever. One and only caveat: Just make sure you get enough vitamin D, which mainly comes from the sun and oily fish (at least 1000 IUs a day). Really, really important for development of her bones and you're her only source. Important for your bones too. It's so simple to remedy: I take Nordic Naturals Fish Oil with added vitamin D (1000 IUs) after blood test showed I was deficient. And this shocked me because I am a big milk and yogurt girl! But doctor told me that diet isn't enough. And I have habit of avoiding sun because of skin cancer. Fish and sun are not normal part of our modern urban lifestyle and diet, but our bodies still need these elements. Rickets are coming back! I give it to my kids and they don't mind. My mom, who grew up in MN, laughed and said her mother used to give them all cod liver oil. Here's a recent NYT's piece on breastfeeding and Vitamin D (http://www.nytimes.com/2008/08/26/health/research/26rick.html). Researchers believe we can use a lot more than is "recommended" or added to milk.

Frances said...

My comment pretty much echo what has been said, but I wanted to add our experience to give you some reassurance. Our second son was just like this -- he preferred to nurse and whenever we would try to introduce purred food, his tongue would thrust it out. Around 8 months he could eat cheerios. He didn't start to eat other food until 10mo., at which point we just gave him whatever we were eating, mashed with a fork. He is now 2 and is an amazing eater, eating anything and everything in sight! Another thing -- as a LLL Leader, I always remind moms that breastmilk is the most important food the entire first year, and that introducing solids is to just get them used to different tastes and textures. Think about it, it's not like we eat pureed carrots to gain weight! :)

Alexis said...

I think the Gerber puffs are a good alternative to cheerios to introduce the gumming food skill.

Joanne said...

I am running out of time so I had to stop reading the comments, I'm probably repeating when I say that I think of course she is getting enough from nursing, and if you don't mind, nurse away. My ped (who I love dearly) has always told us that from 6-9 months, food is for playing and most of the nutrition should still come from breastmilk/formula. I totally night nursed my girl until she was 10 months old, same thing, I thought she needed it.

I would also think that you can give her whatever kind of food she does well with.

Also, I think all states have early intervention services available for kids who are having developmental issues. My son is autistic, so we are well acquainted with them for that stuff, but I have a friend who had her son evaluated for some eating issues he was having. It's federally mandated so hopefully your state has a good program.

I'm so happy she's happy and thriving - she sounds like a joy to be around! My girl can be a real grump so it's nice to hear about a sweet happy baby! :)

Juris Mater said...

Wow, you all are SO great. Thank you! Thank you thank you. First, I am SO relieved to hear that it's nothing to worry excessively about. I'm not usually that uptight with developmental milestones, but I've heard stories about occupational therapy for babies with swallowing problems and I think I thought it was more unusual than it is.

I'm also so happy that we can keep up the frequent nursing and not worry about spending so much time force-feeding with a spoon. This is the first time I've really loved nursing, and the more the better!

Angelina does seem interested in food, but not in spoon-fed food. After your recommendations, I tried letting her feed herself small chunks of banana today, and that went surprisingly well. It actually makes sense that uncoordinated tongues would have better luck with a single piece of actual food than a mouthful of watery mush. I think we're going to keep going in this direction. Plus having her practice self-feeding in the highchair buys me some hands-free time! Love that.

Doc Alex, YES, crazy reflux with this girl. She's not bothered a bit by it but she spits up a TON. At what point would you consider reflux medication for the swallowing problems?

Getting to institute Red's "second dinner" is my dream come true. I definitely am having to eat more the longer she exclusively nurses. If I do have to start having two dinners, do I lose my right to make fun of Red and Tex for complaining about becoming too thin when they're nursing?

Yes, Kat and Joanne, Angelina is THE loveliest baby. I feel like God gave me a crown when he gave me her. Have any of you felt that way about a baby? She's the perfect temperament for me to enjoy every minute of, and I've never loved being a mother so much. Thanks be to God for His gifts!

Mary Alice said...

I feel just the same about the Lion, it is like having a baby doll come to life.

Anonymous said...

My niece was diagnosed with apraxia when she was 2. She initially had trouble nursing, but that improved over time, and she had a difficult time eating solids. You may want to look into that.

Alex said...

If Angelina seems happy (which she obviously does) and is maintaining a healthy weight despite lots of spitting up and her swallowing difficulty with solids, I would hold off on seeking any meds for her. If you find that she is not making any progress with the swallowing over the next weeks, and certainly if she starts to fall off her growth curve, talk to your pediatrician because it could be that a simple antacid will help her.

In response to the thoughts about how joyful it is to raise a happy baby, I cannot help but echo the gratitude. Our 5 month old Teo is nothing if not a divinely generous gift from God. He spreads joy to all of us who get to receive his constant smiles and his tranquility. I feel so blessed to be his mother. My husband and I believe that a part of his peacefulness and happiness must come from his big sister, who is certainly giving him a hand from up in heaven. I just wish that I could hold him on my hip for the rest of my life.

Juris Mater said...

Alex, I'm crying after reading what you wrote about your babies. Just got off the elliptical machine, I'm sweating all over the computer chair and crying. That's so beautiful! Thanks be to God. I may go wake Angelina up from her nap to give her 100 kisses... nahhh, maybe 10 more minutes : )

Melanie B said...

You can absolutely skip over the pureed foods and go straight to finger foods. That's what my daughter, now 9 months, did. I tried and tried and tried with the baby cereals and the purees and she was having none of it. So through about 7.5-8 months she was pretty much exclusively nursing and having occasional crusts of pizza or bananas when I thought to give them to her.

When I tried her on Cheerios she loved them and I started giving her small pieces of cooked meats and she loved them too. I figured since she was able to pick up small foods between her thumb and forefinger and to sit up on her own, she was pretty much ready for self-feeding anyway. Baked potatoes soon followed and very quickly I discovered a huge range of finger foods that she loved shoving into her mouth. She just turned up her nose at anything on a spoon. She's very independent, I think.

Now she'll occasionally do a little bit off a spoon, yogurt or applesauce. But she went fairly directly from exclusively nursing to three huge meals a day of finger foods.

And she stopped night nursing at about six months. She'd started sleeping six to eight hours in her second month, and I was never all that concerned about getting her up for feedings. She seemed to thrive and get all she needed during the day.

Best of luck. Hopefully your baby is just like mine and it's just about texture or control and not really a swallowing issue.

"H" said...

Speaking of eating difficulties, any advice for a very active and curious 6-month-old who is too busy to eat? At her check-up last week my little girl only weighed in at the 12th percentile for weight (but she's at 9 month height). She seems healthy in that she's extremely active, crawling and climbing constantly, working intently on learning how to pull herself into a standing position, etc. But I don't think she's getting enough calories--she's always been slim and seems to be getting skinnier by the week. A lot of times when I nurse her she gets distracted and doesn't eat much, and my supply is fairly low too. She eats some pureed vegetables and meats but rejects fruit and cereals. (I call her Atkins baby. I ate low-carb myself for years before I was pregnant with her, but I've been eating moderate carbs ever since I got pregnant--but maybe there is still some connection?) The pediatrician just said to "keep an eye on her weight." Like that's helpful. Any thoughts on how to put some more meat on her bones?

catherine said...

I have not been able to read thru all the comments so this may be a repeat but since my daughter was on the later end of getting any back teeth she was unable to chew anything. She quickly lost interest in pureed foods so I started feeding her Campbells chicken noodle soup. It was a great way to get protein and calories plus she loved the taste! The chicken and noodles were so small and soft she was able to just to swallow them.
Hope this helps!

Elizabeth M said...

Juris Mater,
We went through similar troubles with our daughter, but her difficulty continued. At her age, I'd try the other suggestions and definitely keep nursing.
However, if it continues longer, I would suggest either seeing a pediatric gastroenterologist or at least asking to get a swallow study.
Our daughter also had reflux and it is correlated with swallowing problems. We didn't end up with the swallow study until after she was a year old (long story there). She had 4 forms of swallowing dysfunction and choked easily on liquids (other than breastfeeding itself). Luckily I did keep nursing her and that kept her from other procedures. I won't drag it out here -- but treatment for reflux, feeding therapy, and OT all came together -- both private and Early Intervention. She did learn to eat properly and developed the muscle control.
She's now 7 and healthy, although we have to remind her not to drink too quickly once in a while.
I'm telling you this not to scare you. But I think it is better to be informed in case this continues. Feel free to email me if there's anything I can do to answer questions. I'll try to email you my address.
I didn't want to drag out this comment longer than it is! We had to push to find the right doctor and have the tests done.
Your daughter may very well develop muscle control herself in the next several months -- many do! Just don't be afraid to ask if it doesn't seem to resolve.
God bless!