Suck, Swallow, Breathe

I spend a lot of time feeding preemies -- and teaching their parents to feed them. Often, the parents have the mistaken notion that practice makes perfect. For the adults involved, that may be true. For the babies, not so much.

There is a phenomenon among near-term preemies which demonstrates the issues pretty well for that group. The baby will poke along, choking and dribbling - sometimes failing to breathe as well. One day the baby just gets things together. It's almost magical - as if someone has flipped a switch. I've explained this to countless parents and recently a dad summed it up much better than I could. He said, "I see, it's like walking! He won't be able to do it until he can." The baby's mom was not exactly thrilled with any of us (dad, me, or baby), but she did seem to understand. Good thing. For that particular baby, it was weeks before he managed to pull his act together and nipple all his feedings.

Feeding preemies is much more complicated than feeding healthy term kids. With a term baby, you may have to help them figure out how to latch at the breast (or more rarely on an artificial nipple). Beyond that, the whole thing is pretty much reflex. Preemies have a pretty good suck reflex by 34-35 weeks gestation, but many don't get that swallow part. If they get the suck-swallow, they may not manage to coordinate breathing along with it. Eventually most of them will be able to manage, but it can be very frustrating for the parents while they're reaching that point.

Several things can help. First, don't cold stress the baby. They need to be warm - this often means spending time in an incubator, or at the least being dressed warmly and double-wrapped. Sometimes parents need a lot of education to understand that their preemie simply won't tolerate being unwrapped and passed around the group, especially prior to feedings. If the baby is using excess calories to keep warm, he won't have the energy to nipple or breast feed.

Preemies may not feed well if they are handled a lot or bathed just prior to a feeding. Again, they only have so much energy and need to conserve.

Positioning is important. The impulse is to snuggle the baby in the crook of your arm to feed him. This is a bad idea with preemies for 2 reasons - the baby will probably sleep if you snuggle him, and if he chokes, it will take longer to reposition him to clear his airway.

Choice of nipple can be very important. We have 4 different types of conventional nipples ( and a couple of others for babies with clefts). First is the standard nipple used for healthy term babies. I use that for most preemies as well. Then there is the "orthodontic" nipple which allegedly is more like feeding at the breast. I've never been convinced, but the nipple is quite useful for a subset of babies who choke or dribble, since it places the breast milk or formula in a different spot in the mouth. Another is softer than the others and has a larger hole. It is useful for feeding babies who have the swallow and breathe portions down, but who have a weak suck. Sometimes I use this one to finish a feeding if the baby starts to tire. The last nipple is a "slow-flow" nipple. That one is useful for the babies who have a really strong suck, but are inexperienced with the swallow-breathe portion of feeding.

Breastfeeding has a separate set of challenges in near-term preemies. Most babies take some time to develop an effective latch and suck due to a disparity between baby's mouth size and mom's nipple characteristics. It's hard for the baby to get enough of the areola into the mouth. There are ways to deal with this if the disparity isn't too great.

Mom may need a second set of hands to get the baby positioned and the mouth opened wide enough in some cases. Once the baby latches, mom needs to pull the baby in closer while she (or someone else) presses down gently on the chin to get the mouth open wider. As with term babies, it is important to make sure the lips are turned out, not in. In extreme cases, it may be necessary to use a nipple shield (silicone is best according to our lactation consultants) until the baby grows a little. I encourage the mom to try without the nipple shield first - only for a few minutes if it isn't working.

Dribbling and choking aren't a problem for breastfeeding babies unless the mom has an especially vigorous let-down. That can be managed too. We sometimes have the mother pump her breasts for a few minutes before letting the baby nurse. Estimating intake can be an issue. In most cases, we just weigh the baby's diapers to make sure he isn't getting dehydrated. In special circumstances, the baby is weighed before and after feedings (dressed and diapered). That allows an estimate of intake if that is necessary.

$10.9 Million for the Good Guys

I can't embed the video but it's worth watching.


A federal jury in Baltimore, MD awarded $10.9 million to the family of Lance Cpl. Matthew Snyder. They found that the "protest" by the Westboro Baptist Church wasn't protected speech.

The members of Westboro Baptist Church have the right to their beliefs. They have the right to meet and to discuss them. As Lance Corporal Snyder's father says, they even have the right to express them in public places - in front of courthouses, public parks or streets - yes, even outside the U.S. Naval Academy as they did this week. I really do not believe that funerals are the sort of public venues where they should be able to express their views. I'm glad the jury feels that way as well. This will be appealed, of course and I hope they lose on appeal.

I'm not going to post any links to WBC. They're easy enough to find. I am going to throw in a plug for the Patriot Guard who have been attempting to shield military families from the vitriol of WBC actions at funerals across the nation - with permission of the family. They do this through strictly legal and non-violent means. More recently, they have added Honor Missions to deceased veterans and law enforcement personnel.

Enter the Samurai

This is what has kept me busy all week. The helmet (kabuto) took the bulk of the time with the body armor (Do) a strong second. Lots of duct tape and foam-core poster board went into the armor. It's still missing important pieces for authenticity -- waist, leg, and throat armor to start -- we'll be working on those later. He's really pleased with his wins for scariest and most original in his age group at 2 different contests.

Been a little busy

Armor is as finished as it's going to get. Pictures will be ready by Sunday - 2 costume contests in the meantime and his dad will be there with the camera.

My son is very excited. I'm really pleased with the way it's turned out. We'll be adding to it on an ongoing basis until it's really completed, but it will do for now. Next project, find the local Society for Creative Anachronism because he wants to learn much more about the making of armor, SCA style. And I didn't even tell him that they get together on Sundays to practice archery.

We did learn some things. You can do pretty amazing things with tinfoil and duct tape.

We also learned that it's a really bad idea to put on your gauntlet (forearm armor), which is made in one piece(not at all like authentics Samurai forearm armor), and slide it up over your bicep. Since it was made of posterboard and duct tape, scissors solved that problem. THEN I realized it probably would have come off the way it went on - with his hand straight up over his head. Not planning to test the theory, though. It takes a good 20 minutes to make a new one and I'm running out of patience. Lots of duct tape left, though.

Pictures coming soon

Samurai armor is definitely the most challenging project we've attempted in a while. The helmet is nearly finished and the armor is coming along nicely.

We followed the directions on the Clan Yama Kaminari "How to make armor" page using foam core poster board covered with Duct tape instead of the plastic barrel they recommend. It's easier to cut than the plastic and he'll outgrow it too soon to make it worth going through all that. Also, he doesn't plan to go out and pound on people with sticks while wearing this. They only wear headgear and hand and foot protection when they pound on each other with sticks in his karate class.

Unlike the barrels, foam core poster board isn't flexible, so I cut part way through at 1.5 inch intervals on the side panels before applying black duct tape. This allows the armor to bend in order to fit. Instead of taking the time to lace the panels together, we used red duct tape for the hinges. We will be lacing the upper pieces to the front and back as well as the shoulder straps. Torso armor (Do) should be completed by tomorrow evening. Helmet (Kabuto) shortly afterwards. If we have time, we'll add additional pieces as we have time. Armor should be completed in time for next year's Renaissance festival (or an SCA event if we can find one nearby sooner).

shirt.woot derby #13 - Halloween

Shameless pimp here. My friend has a shirt in the derby and will probably enter more. If you've ever bought anything on Woot or shirt.woot or wine.woot you can vote.

Shirt has been axed twice for technical reasons. Rats. It had moved up to #33 before getting cut this time. They reject many outstanding designs because they'd be too hard to print. This is one of them.

There are lots more choices in the derby, though. You can see the rest of the entries in the derby and vote. There is some really clever stuff there.

Halloween is coming!

My youngest son has designed his own costumes since he was 5 years old. My job is to help implement them. This gets more challenging every year. Considering that his first (prize-winning) costume was a hammerhead shark, that's saying a lot.

This year I may need to swap him off to someone from the Society for Creative Anachronism as he wants to be a Samurai Warrior. With armor. So far, we've figured out how to build the helmet - recycling the Clone Trooper helmet from a few years ago as a base. He's hoping it will look a little like this one:


which we found on the projects page of Clan Yama Kaminari. He wants the whole shebang, so this is going to turn into a long-term project.

Ideas and helpful hints found here

We won't be using the face guard and our helmet started its life as a green military-style helmet which I spray-painted white for use as a clone trooper. It will change color again in this incarnation. He wants it black this time. My plan is to cover it with wedges of black Duct tape so it has a more authentic appearance than simply spray-painting would provide. Also, this makes it possible to construct the remaining part of the helmet in a manner which will match the top. Pictures to be posted as we make progress.