Discharge Feeding Recommendations for Camryn Miller

7/15/99

1.       First and foremost we want to make sure that each feeding interaction is pleasurable for Camryn.  This is very important (and also a challenge).  We want her to have a positive attitude about eating.  She also needs to feel in control of the interaction.

2.       The following are strategies that will help Camryn be relaxed and comfortable during each feeding.

a.       Wait for Camryn to demand her feeding and get her started as soon as she wakes up so she’s not agitated before the feeding begins.  It’s ok to feed her even if it’s only been two hours.  Sometimes babies with reflux are more comfortable eating small amounts more frequently.

b.       When giving her a bottle, hold her so that she’s positioned upright (like when in her bouncy seat) without scrunching her legs.  Pressure on her stomach can increase reflux.  Bring her arms together so that her hands are at midline on her chest.  This position is calming and I physically contained her arms in this position during feeding breaks when she was starting to flail and get upset, and she settled in a couple of seconds.  Flailing of her arms can just increase her agitation.

c.       Firm patting of her bottom, offering her pacifier and singing a soft lullaby helped calm her when she started to fuss.  Her pacifier is a great tool as sucking helps calm reflux.  If she starts to pull away from the bottle and has already burped, but refuses the bottle nipple, I’d offer the pacifier and get her regrouped rather than continue a pattern of fussing during the feeding. 

d.       Camryn is already very easily agitated when the bottle is offered and she doesn’t want it.  She gives a big response rather than just a simple turn of her head or closure of her mouth.  Let’s help her realize that she doesn’t need to fight and resist the bottle and as soon as she resists, stop and get her calm before trying again.  When the reflux settles down, she’ll settle down. 

e.       During breaks to burp or regroup, try to move her slowly and minimize position changes as movement can increase reflux.  She burped well by just bringing her slightly forward in a sitting position. 

f.        Continue to limit feeding interactions to 30 minutes or less and stop as soon as she gives you the cues that she’s done.  I tried burping her and offered the bottle about three times after she said “No” and then quit offering.  Each time, she started to get upset, so I immediately helped her stay calm and regroup before offering again.  I can’t tell you how important it is for each feeding interaction to be pleasurable for Camryn.

g.       Continue to provide an environment that has few distractions while she’s eating. 

h.       Position Camryn upright either held or in her bouncy seat for 30-60 minutes after a feeding.  If she needs her diaper changed after a feeding, try to avoid scrunching her legs into her stomach and use a “roll to the side” technique. 

i.         Consistency is important.  Camryn will then know what to expect and trust that the feeding interaction is going to be a pleasurable and satisfying experience.

I hope that these suggestions are helpful.  It has been wonderful getting to know you and I wish you all the very best.  You finally made it!  See you in a few weeks.