Clinical Support of Infant Sucking Skills Lecture Pack

Well-organized sensory systems provide the foundation for relational feeding. Sensory interactions communicate the story of the dyad, a window into strengths and challenges. Encouraging families to attune to their own sensory preferences and that of their infant can significantly influence the dynamics of the body/breastfeeding relationship. This presentation will explore the basics of sensory processing as it relates to provider, parent, and infant co-regulation in the context of body/breastfeeding and lactation support. We will explore basic neurology and cultural influences of the 8 senses though dyadic examples. Ways in which subtle signs of sensory disorganization and sensory processing disorder present in body/breastfeeding relationships will also be reviewed. Participants will learn practical strength-based sensory strategies to support families in the beginning stages of life, feeding, and beyond.

In order to identify sucking dysfunction, it's important to first know what normal looks like. Being able to do a thorough oral assessment of an infant is a crucial skill for IBCLCs. The focus of this presentation is to discuss what to look for when performing an oral exam, as well as how to assess oral motor function as it relates to infant sucking skills. Knowing how the anatomy affects an infant's oral-motor skills is crucial to determining the cause of breast/chestfeeding problems and suggesting proper treatment.

For an infant, breast/chestfeeding and sucking is the normal form of feeding. If an infant is born with an underlying neurological, muscular, genetic or anatomical disease or if neurological changes occur due to complications, this form of feeding may be disturbed. Since the interaction of breathing-sucking-swallowing requires the coordination of over 60 muscles and several cranial nerves, even small changes in physiology can throw the system out of balance. Congenital-Heart-Disease, Down Syndrome or a disorder of the central nervous system due to pre- or postnatal trauma, infection or structural defect differ in their symptoms, but what they all have in common is that sucking and oral intake of food can be impaired. When working with infants or lactating parents, children with sucking disorders due to an underlying disease may also be present. It is important to know which underlying diseases can have an impact on sucking and how the children and families can be supported to enable or improve oral feeding and to be able to assess which interdisciplinary team would be useful to ensure the best possible care.

One of the most complex and challenging tasks required of an infant in the neonatal ICU (NICU) is oral feeding. Oral feeding progression is also one of the most critical pieces of the discharge puzzle. Depending on their medical and nutritional needs, these infants often experience procedures like intubation and/or placement of medically necessary interfaces like nasal prongs, CPAP masks, orogastric and nasogastric feeding tubes. Intra-oral presence of tubes paired with the sensory motor implications of tape used to secure these interfaces and the overall challenges of a developing infant in the ex-utero environment places these infants at risk for oral feeding difficulties downstream. This presentation will provide participants with ways to support the developing oral structures and subsequent oral motor and oral sensory components of a neonate in an attempt to support breast and bottle feeding progression in the NICU.

This presentation will discuss the difficulties that surround defining and assessing for tongue-tie. It will explore what we know about the role of the tongue in infant feeding by reviewing evidence from ultrasound studies and other research on latch and examining what this tells us about the normal functioning of the tongue. Various available assessment tools will be described along with how these may assist in differentiating between a normal and abnormal lingual frenulum. Also discussed will be other causes of tongue restriction and how to differentiate these from an abnormal lingual frenulum.

IBCLCs assess chest/breast and bottle feeding skills and infant’s oral and body anatomy, and the motions that contribute to, or inhibit, the process of feeding as well as post-feeding comfort (digestion and elimination for infant, breast comfort for parent). When infants present with feeding dysfunction, the root of the issue could be from a variety of sources - effects of in utero positioning, prematurity, effects of birth interventions, tight frenulum (ties), asymmetric/tense muscles/fascia, neurological/ reflexive issues, low/high muscular tone, or suckling discoordination, suck-swallow-breathe discoordination, laryngomalacia, compensations for low supply, cleft lip/palate, and more. IBCLCs help families navigate the differential assessment of feeding dysfunction, and at the same time support the family’s feeding and milk supply choices.

This presentation will examine the role of the IBCLC when suckling dysfunction is occurring - for example aiding with latch and bottle feeding, oral/body exercises, referrals for oral evaluations and/or bodywork, or help with frenotomy pre/post work if needed. IBCLCs adjust the care plan as the infant’s feeding skills and parents’ goals grow and change. Developing the skills to aid oral function, and coordinate with specialized practitioners to aid this process, is crucial in order to determine the best course of clinical care, meet the families needs, and allow for the best possible outcome.