Multi-Tasking from Birth
“Suck. Swallow. Breathe.”
Until about 34 weeks gestation, babies have not yet developed the skill to coordinate sucking, swallowing and breathing. Premature babies born prior to this skill developing will have to be fed either with a feeding tube inserted through the nose or mouth that leads to the stomach, or intravenously. Here, you can see Flynn’s feeding tube that was placed in his nose for his first months of life.
A preemie without a mature suck and swallow will burn excessive calories and easily become exhausted during a feeding session. I remember when Flynn was transitioning to a bottle and his bottles held just 20mL of formula (feeds are measured in milliliters because the amounts that they consume are so minimal). We had to limit the time allotted to finish his meal to thirty minutes so that he didn’t burn more calories than he consumed. The majority of the time, he wouldn’t finish that 20mL and we would have to cut him off. To put this in perspective, the standard baby bottle can hold 8oz. A full-term newborn drinks about 3oz per feeding, and 20mL is equivalent to about 0.7oz (slightly over 4 teaspoons).
Babies who cannot suck, swallow, and breathe well are scary to feed. They start off great, but they may realize pretty quickly that it's time to breathe, and they aren't quite sure how. They may choke, gag, or stop breathing entirely. Shortly after we were sent home from the NICU, Flynn stopped breathing while drinking a bottle. It was the first time we’d had to handle this without nurses to help us and we panicked and rushed to the emergency room. He ended up fine and, because this wasn’t the last time this happened, we were more prepared the next time. A baby that stopped breathing occasionally, for a multitude of reasons, was somewhat common for us.
The ability to either breastfeed or bottle-feed is a skill that is important in order to be discharged. Some children, for a variety of reasons, may be sent home with a gastrostomy tube (G-tube), however. We were not one of those (amazing) families, but there was a point after his first birthday where during discussions of “failure to thrive” where a G-tube was considered for Flynn. Feeding and growth has consistently been a struggle for our family, but that’s a long story for another day...