Getting Back on Track when Responsive Feeding Goes Awry

So... we're sure you've been waiting with bated breathe to see how feeding therapy helped get Ella back on track, and her family on board with cue based/ responsive feeding. But honestly, it was not as simple as we all would have hoped. Situations like Ella's are complex, and sometimes, we don't completely "solve" the problem.

After the feeding therapist completed a thorough evaluation, it was determined that although the baby did have a prominent lingual frenulum, it was not restrictive (this is a bit of a soapbox topic for us, so we will hold back and not get into too much detail here). Was the frenulum slightly short? Yes. Was it getting in the way of tongue range of motion, strength, latch, or swallow function? The answer to this was a resounding NO. Overall, the baby's oral motor skills were appropriate to support bottle feeding and swallowing was not the problem. The only objective data collected was early shut-down response during feeding.

Falling asleep vs “shutdown”

For therapists who are new to baby feeding, there is a distinct difference between falling asleep due to fatigue and shutting down (neurologic response). In Ella's case, she demonstrated classic shut down--after about 10 minutes of guarded feeding, she would stop sucking. But once she was placed back in the crib, she would wake, cry, root, and show feeding cues. Her body was still hungry, but so stressed by the feeding experience that she neurologically shut off. Amazing to see that it only took ONE WEEK for baby Ella to learn this adaptive behavior.

So in chasing one of the why's we had an answer: Ella's poor feeding/intake was initially due, most likely, to being immature at birth, which impacted her ability to stay awake long enough to complete feeds. Then you add in the stress of being separated from mom, who is essential in those first days for co-regulation (the ability of the parent to help a baby achieve a just-right state of regulation) and then last there is dad—who was doing what he had been told in terms of walking and pushing Ella to eat, but who was having trouble getting Ella regulate because he himself was anxious and stressed. Her immaturity + losing mom as a co-regulating force + putting it all on dad who was also stressed and disregulated AND who had been given instruction to make sure baby stayed awake and ate, caused a perfect storm which appears to have led to force feeding over a period of about a week, which baby Ella responded to by going into neurologic shut down after a short period of bottle feeding to protect herself. It’s worth noting that force feeding often sounds very harsh- like the parent isn’t connected or loving. But this dad was extremely loving- he was just also extremely worried about Ella doing well and gaining weight, which led to him missing her communication and pushing her a bit too hard to eat.