1. Keep your baby’s head in alignment with her body(Keep the head, neck, and body in a straight line).
2. Do not allow your baby’s head and neck to extend backward.
Hyperextension of the head and neck can cause some irregular patterns to occur in your baby’s mouth. These patterns include wide jaw movement, excessive tongue protrusion, tongue humping or mounding, and biting down for stability(ouch for the breastfeeding mom!).
Note for Breast-Feeding Moms: Your lactation consultant may teach you to have your baby latch by leading with the chin. This will help your baby open their mouth wide. Once your baby is latched, be sure her nose is close to your breast. This allows a proper extension in your baby’s neck without Hyperextension. Your baby may slightly adjust the position so she can breathe, but her nose will be very close to your breast.
3. Keep your baby’s ear above the mouth so that fluid will not enter the Eustachian tubes. This means holding your baby when possible at approximately a 45° angle or more. As your child grows, she can be more upright. This is critical for bottle-fed babies. If your bottle-fed baby is positioned at 45°to 90°, then your bottle can be held in such a way that gravity does not make the liquid flow too fast.This is spaced bottle-feeding. The Breastfeeding Mother’s Guide to Making More Milk, a book by Diana West and Lisa Marasco, contains detailed information on paced bottle-feeding, which is similar to breastfeeding.
- Stroke the baby’s lips with the bottle nipple.
- Roll the bottle nipple into the baby’s mouth when she opens the mouth wide, demonstrating readiness to accept the nipple.
- Allow the baby a break after four to five suckles by stopping the liquid flow(ie, gentle nipple removal from the mouth or tipping the bottle).
- Use a slow-flow nipple.
- Keep the baby more upright and the bottle more horizontal to reduce the effects of gravity.
- Follow your baby’s hunger cues to avoid overfeeding.
Note for Breast-Feeding Moms: If your baby is breastfeeding properly, it is unlikely that fluid will enter the Eustachian tubes because the pressures within the mouth and nasopharynx are equalized. Breast milk is s” living tissue,” and macrophage cell activity in breast milk may destroy bacteria in the Eustachian tubes if any milk should enter them. Macrophage cells are the most numerous cells in breast milk. They appear to have antibacterial characteristics to assist the baby in the development of a healthy immune system. When you first breastfeed your baby, the cradle hold or side-lying position may work best for you. Many lactation consultants recommend the cradle hold. However, new information is available on breastfeeding positioning. Suzanne Colson and colleagues have written several recent articles on the topic of breastfeeding positioning. The articles discuss research and include photos of appropriate breastfeeding positions.
Colson and colleagues demonstrate that the newborn may actually be an abdominal feeder, with antigravity reflexes assisting the latch. At this point, do not become overly concerned with your baby’s ear being above the mouth if you are using a cradle hold or side-lying during breastfeeding. Be sure your baby’s head and body are in the best alignment possible(ie, the head, neck, and body are in a straight line with the nose close to the breast). You can move to a football hold when you and your baby become more skilled with the nursing process. This hold will place your baby’s ear above the mouth. Breastfeeding has so many health benefits for you and your baby that it is important for the two of you to find a way to successfully breastfeed.
The positioning of your baby while he or she bottle-feeds can be very important. While research is needed, it has long been suspected that babies who are bottle-fed lying down have a higher incidence of ear and sinus infections. This is related to the positioning of the Eustachian tubes, the sinuses, and gravity.
The Eustachian tubes are positioned horizontally in the newborn and become more vertical as the child grows. Each Eustachian tube(One in each ear)leads from the back of the nasopharynx(Where the nasal area meets the throat)to the middle-ear space. Fluid is more likely to enter the baby’s Eustachian tube if the child is lying down because of gravity pulling the liquid downward. Figure 1.1 in chapter 1 shows you the location of the opening of the Eustachian tube.
If fluid from the bottle or the stomach(due to reflux or spit-up)enters the Eustachian tube, it can travel into the middle-ear space behind the eardrum. This space is essentially a sinus as it is lined with mucus-producing membranes. If a foreign substance enters this area, more mucus is produced in the body’s attempt to clear away the foreign substance. This mucus build-up in the middle-ear space can become an ear infection.
When your baby was born, a gelatinous substance filled the middle-ear space. However, this substance is absorbed during the first few weeks of life, leaving an open middle-ear space. The middle ear contains three little bones that help the eardrum communicate sound to the inner ear. If the middle-ear space is filled with fluid or infected mucus, your child may have a significant hearing loss.
Having a healthy middle ear is important for your child’s hearing and speech-language development.
Fluid in the middle ear can distort the way your child hears sounds. It may be most similar to when you hold your fingers in your ears or hear sounds from underwater. Children are learning to discriminate the sounds of their own language from birth. Discriminating the different sounds of speech allows the child to learn language and speech. Therefore, your child’s middle ear needs to be kept clear from fluid or infection.
Sinus infections can also be caused by foreign matter, such as reflux(commonly known as spit-up), entering the nasal sinus areas. Despite the cause, sinus infections or congestion make it very difficult for your baby to feed. This is the reason that most parents use a hand-held suctioning bulb to clear the baby’s nose of mucus.
When babies feed, they coordinate sucking, swallowing, and breathing in a sophisticated manner. A stuffy nose may cause your baby to struggle with this process and possibly compensate by taking more breaths through the mouth. Long-term mouth breathing is unhealthy and makes it almost impossible to adequately coordinate suckling, swallowing, and breathing. By bottle-feeding your baby at a 45°to 90° angle(with the ear above the mouth)with the head and body in alignment, you can help your child avoid ear and sinus problems.