Wednesday, 16 November 2011

Why Doesn't She Eat?!

People often ask "Why doesn't your baby eat?", "Why don't you try harder to get her to eat something?" I get questioned why I feed her with a syringe or pump and a tube and I get a lot of questions about how it all works. Here's my answer!

Cerebral Palsy affects muscle tone and the ability to control muscle movements. In Bree's case she has what is referred to as Spastic Quadriplegia Cerebral Palsy. This simply means her muscles are always tight and it affects her entire body

Did you know something as simple as eating uses 20 different facial muscles? Add in the ones engaged to sit upright including the head and trunk and all of a sudden feed time is a huge workout!

Unfortunately so much of a person's development is directly related to their ability to feed.

Feeding skills first start to form in utero when the baby makes sucking motions and sometimes even finds a thumb to put in their mouth. When bub is born they further develop as they feed, through the sucking and drawing movements they use to take milk. As a baby reaches the 4-6 month milestones they use their oral skills to mash food with their gums and drink from a sippy cup. Later this turns to chewing and sucking from a non spill cup and before you know it you have a toddler that eats and drinks anything!

As the oral skills used for feeding develop so do the ones for speech. If you think about a baby's vocal skills you can see the direct relation. When a baby is first born they make noises from their throat, we know this as crying. As they develop their skills they start to make gooing and gaaing noises, this turns to simple words such as "dada" and "mama". From here the first words will form and an understanding of language develops as well.

Although these seem like simple progressions the processes involved are great. There is a lot of mouth and tongue control needed to mash pureed food between your gums and push it down the back of your throat. These are the same muscles you use to form those first simple words.

Ideally we want to encourage speech and oral feeding so we work on Bree's oral skills every day. We call it speech therapy and she has a specialist she sees regularly for this. It really means that we give her small feeds throughout the day so she can practice using those tongue and mouth muscles. We also do tongue "exercises" and place pressure under her chin so she is more aware of the muscles she needs to use.

We are having success with this, slowly, but surely! Bree can make a lot of noises from the back of her throat and also says some simple words "daddy", "mum", "hey" and "no". She doesn't say them a lot, but she can form them at times.

Unfortunately there is absolutely no way that Bree can eat enough in a day to maintain her weight. So while we spend a lot of time and I do mean a lot feeding Bree orally each day this is not actually how she receives her daily requirements.

To ensure she receives enough nutrition throughout the day Bree has a feeding tube. Originally this was a Naso Gastric Tube which went through her nostril, down the back of the throat and into her stomach. This is a short term method and is quite often used in premature babies at birth. As we are looking at tube feeding being a long term solution we now use a slightly different method that works in much the same way.

Bree now has a Gastronomy Tube, or G-Tube for short, this is a one way valve that goes directly into her stomach. A hole has been made, much like when an ear is pierced and a "button" has been placed externally. It is hidden under her shirt most of the time and when she needs a feed we simply open the valve and "plug in" a tube, we use a syringe to push her milk through. We also have a pump which we can use to give a set amount over a set period. It did all seem a little bizarre and overwhelming to start with, but this is our normal now.

So why doesn't my daughter eat and why don't we try harder to get her to feed?

It's not a case of Bree not eating, she spends a lot of time eating. She simply can't control her muscles enough to eat the amount she needs to.

Simple, right?!!

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