A Very Bad Pacifier

Very good in NICU, but using this pacifier with older infants and children creates problems with feeding, tongue and teeth.

About 20 years ago, a new pacifier came into production designed for babies in NICU.  It was completely latex free which was it’s feature.

It is OK for very small NICU babies… definitely not OK for bigger babies.  This is why.

Teaches bad sucking:  There are 2 ways a baby gets milk out of the bottle or breast; by sucking, an event that uses tongue, palate and cheeks to pull a stream of milk out and by chewing the end of the nipple which only empties milk at the end of the nipple into the baby’s mouth.  A full term baby is born knowing how to suck, he has probably been sucking a thumb for months, but not so the preemie.  Sucking occurs at the back of the tongue and he must be taught.

Keeps the tongue in the front of the mouth or sticking out of the mouth: There is not enough of a hub on this nipple to capture for sucking or to keep the pacifier from falling out of  the mouth when at rest. Therefore the baby must press it against the top of his mouth with his tongue, and this is a mistake.  You can understand the problem if you put this pacifier in your mouth and attempt to hold it in place without using bottom teeth.  Then try sucking on it, there is no bulb to keep the back of the tongue down and curled… no way to engage it to suck and therefore it essentially blocks the throat.

Risking ‘buck teeth’:  The basic physical things a baby learns remain his preference for a lifetime.  Learning to apply pressure with the tongue against the upper ridge of teeth will possibly cause him to tongue-thrust during deep sleep.  This applies heavy pressure against the back of his upper teeth, pushing them outward.  Braces will change it but his tongue thrusting will continue recreating the problem.  The tip of the tongue has a normal position, gently resting against the upper palate.

For more pacifier tips and tricks see PACIFIER posts on sidebar.

Preemies are Survivors

Preemies are happy all their lives… there’s a reason.

Comments we get from parents of children who were very tiny preemies are ‘he is so feisty’. The baby is thinking and problem solving all the time. He’s going through Rites of Passage  events akin to the Indian boy in the Sweat Lodge, the African boy with tribal scaring  a first skydive or standing on a mountain top.  But he is going through it at 1 pound. He will come out, smart, fearless, and happy. These kids are always happy. Think of it. Life is just getting better… all the tubes are gone, he is held by those he loves dearly, he rides in a car, home is wonderful and he spends time outdoors. Every day is better for him and he is learning to expect that in his entire life.

Teaching a Preemie to Suck

There is only one pacifier shape that teaches good sucking.  All others, except the Nuk, work against it.

Because of prematurity the baby is born before the full, strong sucking reflex was established.  He must be taught to suck,  to gain cheek muscles,  to learn the correct combination of sucking and pulling without air leaks and to transfer these skills from the bottle to the breast. Working in NICU for 20 years, I’ve used this system of teaching sucking efficiency with hundreds of babies and it works every time.

  • Hold the bottle near the neck with the thumb and middle finger and using your last 2 fingers, support him under the chin, then when he starts sucking, put traction on the bottle. The chin support  brings the jaw forward and the tongue forward and his response to the traction is to curl his tongue around the nipple. This with the ring of the nipple against his mouth gives a firm, efficient package and he will begin to build up strength, cheek muscles and stamina.  He will take a few sucks and then stop to rest.  This is hard work for him in the beginning.  Some nurses twist the nipple repeatedly in the baby’s mouth, others pump up and down or back and forth. The baby will not learn to suck if that’s the case. They are simply expressing milk into it’s mouth. (and it makes me crazy)
  • The Pacifier. There is only one pacifier that teaches them to suck correctly. It’s the original Binky (pink image below), a rather large, rounded bulb with a stem fitting into a curved mouthpiece. This thing is magic.  It will teach him to suck at breast like a normal newborn. Email Binky (Playtex) and ask where to buy them near you.  The NUK pacifier was designed by a German orthodontist to bring a receding chin out and it does not strengthen the tongue.  Other pacifiers are either too short, too straight or too flat, preventing the infant’s learning a good tongue curl and grip.

 

 

 

 

Gerber is again marketing the original Binky for which every parent should grateful.  It’s called First Essentials and if not in your grocery stores, it’s available on Amazon.

Holding and Carrying the Baby

First time parents are afraid to touch the tiny baby and handle him stiffly but there’s a way to fix that. Before a feeding, sit with your partner, cross legged on the bed and practice handing the baby back and forth, putting him up to the shoulder, different feeding positions and practice the football hold. (Holding his head in your hand, his back along your forearm, legs on either side of your elbow.  This allows you full control, he can see your face and you can clamp his leg against your body for a more secure carry.)

About sling carriers… with a one piece cloth sling carrier,  gravity forces the newborn down into a deep curve at the bottom, bending his head so the chin is tight against his chest.  This can obstruct, clamp-off the airway.

Important in an infant carrier is stability, supporting the head and exposing the face to air. The perfect front or back carrier and one that keeps the newborn’s chin up and carries  growing children easily is the Boba,  (formerly SleepyWrap). Their page of pictures is very exciting. Almost makes you want to have another baby!

 

Preemies are Overprotected

They are made of tough stuff and fearless.  Here’s a story.

The mother of one of our smallest, in NICU for a year (20 years ago, with new technology that never happens any more) and trached at home for two years more called into NICU one night and said she felt awful.   Ryan  was jumping on the sofa, fell off and broke his arm.  I told the nurses working nearby and they cheered!  The mother on the phone asked what that was about.

I told her they were cheering her because preemies are so tenderly overprotected as they’re growing up that they can never experience life.

Your preemie as a toddler will climb on a chair and jump to the sofa. Again and again.  Even falling does not stop him.  I wondered why this was so common.  Maybe because he has learned to trust.  He trusts people because everyone in this NICU experience was essentially kind to him, and gentle.  But he also has learned to trust space!  Infants understand perspective and there are studies where a deep floor of black and white squares was painted on the bottom of a large sheet of glass.  The mother was on the far edge and the newly crawling baby near the opposite edge.  The mother called him to her and he crawled to the part of the glass painted with his edge, saw what appeared to be a drop-off and would go no further.  So why do preemie infants seem to not react to the drop-off?  It may be because he has lived in a glass house, perceived that it was high and was not worried about the consequences of falling.

The truth about preemies growing up is that they are made of strong stuff, happy, brave, daring, smart.  Enjoy them.

Bringing Baby Home to Pets

Bringing  a new baby or preemie home to a family that includes dogs?  Here’s a bonding trick.

Take a clean piece of cloth, a wash cloth, or maybe use a worn out NICU shirt they are going to throw away… one for each dog, and shortly before the baby goes home, ask the nurse to put it in the crib, next to the baby.  If it’s a shirt, put it on the baby.

Then carry it home in a plastic bag to insure the baby’s smell is strong, and one by one, give each dog in the family a treat, pet him, talk lovingly to him and then give him the shirt to smell.  Then put it into the dog’s bed.

Repeat this for each dog.  They will then bond with the baby before it comes home.

Baby's Head Shape

About fifteen years ago, researchers did a world survey about SIDS and found that SIDS was low in China and Eastern Europe where children slept on their backs and very high in New Zealand and Australia where children slept on their stomachs (on sheepskins, the real kind from the sheep).

From this, rules for positioning newborns changed.  Sheepskins were gone and babies were placed on their backs, flat or gently tipped to the side.  Incidence of SIDS fell dramatically and many of the remaining SIDS happened at daycare.  (Read SIDS and Daycare post).

Until the 1940s, babies in America slept on their backs and children had round faces.  (See Change Your Baby’s Head Shape post). Then it was said that if a child slept on their back, it could vomit, aspirate and die.  THIS IS NOT TRUE.  The only group that cannot clear their vomit sleeping on the back are adults too drunk to wake up. Now children sleeping on the stomach had long, narrow faces and this became the beauty standard in America.

Sleeping on the back will give the child an entirely different look. The face is now wider and called ’round’ or ‘square’ and no longer ‘oval’.  Ears stick out in a charming way because the baby is not lying on them.  Eyes are big because the bones behind the eyes are now flattened a bit and eyes are no longer deeply recessed.  The entire look is beautiful and now corresponds with the beauty of European women such as Penelope Cruz for example.

Change Your Baby's Head Shape

A baby’s head is bigger in ratio to the body than adults by a large factor.  It would be as if we were dealing with a head that weighed 70 pounds with no neck muscles.  Newborns for the first 2 months are unable to lift their heads and remain rooted to the spot.  Newborns on their backs cannot even turn the head.

Because of this, the normal rounded back of the head forces the baby’s chin to the chest position (which you don’t see from the front and which is not good for maintaining an open airway), and the head from neck up  becomes flattened from it’s weight.  Weeks and months of this position leaves the baby with a flat head coming to a point and as an adult, he will be heartbroken.  (Adult women can hide it somewhat by fluffy hairstyle.)

Long term preemies in NICU began to show this headshape change.  P;acing a folded blanket under their backs, from the shoulder down, allowed their head to remain on the unraised portion of the bed with less of a weight factor.  Then I would put one of the Ross cards on the top of the isolette dome and they turned the head to look at it.  Now the newborn could freely turn his own head and create a nice shape to it.

You have 6 months before the bones of the baby’s head are solid to the point they will never change shape:

  • Raise his body by padding under it, with a thin blanket folded,  from shoulders down when in bed.
  • Same thing in the stroller, jump seat etc.  Pad from shoulders down, keeping alignment of the head with the chin in a straight line, not tilted down.  Tilting down bends the airway.
  • Padded inserts to car seats and strollers that form an arc around the child’s head force the chin down.  Without the arc, the baby’s head will fall to the shoulder when he sleeps so do what mothers have done forever, prop it up with a folded cloth or stuffed toy.

Preemies as Genius

Now for some fun. When he’s at the point where he’s held, fed, contented and you sit with him on your lap, position him so he can see the ceiling and watch his eyes…  you can tell what he’s thinking.  Preemies, more so than normal newborns, are very alert and problem solve. (newborns are not that alert until about 4 months. This is because all the while these NICU events have been going on the preemie has been figuring them out.)  The artist’s foundation of IQ is pre-cognition, finding the problem and then solving it and, applying this theory to everything in life, these preemies become masters at it at about 26 weeks. I have hundreds of stories.

While watching hundreds of babies during thousands of feedings over 20 years in NICUs, I’ve come to believe that we are all born genius and what happens to us from birth on determines if it’s supported and nurtured or harmed.

Preemies and newborns focus on straight lines. Watching their eyes as they look at a large square black and white checkerboard you see that they are doing two things, they trace the outline of the shape and then compare one to the other. Always in that order. Then they recognize perspective. If you place the grid so one edge is in their direct vision, they will see the perspective and begin to compare only the closest and furthest. You will also see that their attention span is very long. I would time them and the range was from 18 to 26 minutes.

Our NICU ceiling was about 10 feet above the baby in my arms and it was made of white acoustic tiles set into a white metal framework. After the first intense minutes of sucking, he began tracing the shape of the closest, then the one next to it and kept going… learning that they were smaller each time and continuing to the point they would arch their backs to see further down the line. Then they would compare the very smallest to the one above their head, recognizing perspective White on white, ten feet away. (the warm-nummy theory in America about how life works is that the baby can only see as far as the mother’s face. What nonsense.) The edge of our NICU had a narrow ridge of lights behind white louvers extending 40 feet and with this they saw a bold example of perspective. So their vision extended to at least 40 feet.

Eventually I began to wonder about the socio-economic standing of the family and learned that this brilliance included all babies who were not drug effected.

When you take him home, videotape him as he examines his surroundings. The living room for example. Then watch him every time you bring him into that room. He will reexamine it all, again and again until he knows it all. Then sit in a different place in the room and watch what he does.

Play Mind to Mind Games With Your Preemie

Preemies and infants are bored.  Forget the American adult  bias that infants are blank slates.  They are thinking and problem solving, just as we all do, with all the assessment skills and conclusions we have and probably more because theirs is pure and without the influence, fear and worry acquired during childhood.

You can play silent mind games with them and see that this is true.

The first time I posted this design on the outside of the isolette of a baby who was 2 weeks old and now 29 weeks gestation.  She was not supposed to be born for almost 3 months.  I watched  as her eyes outlined each side and compared it to the other, again and again, over and over.  She would just keep doing it and I had to feed the next baby so I began to time her.  Twenty three minutes.

Then after a few days of this, when she was asleep, I rotated the card 1/3 of a turn and stood, waiting for her to wake up.  She opened her eyes, looked at it, frowned, cocked her head, straightened her head, pulled her neck back, pushed her face closer…  the classic ‘double-take’ sequence.  She had immediately identified the problem, checked her facts, verified what she was seeing and accepted it.  She weighed less than 3 pounds.

So I did this for at least a hundred babies over the years.  Stable feeder /grower babies, all with the same results.  The attention span time was from  18 to 26  minutes.

We are all born genius.

Visual Stimulation Cards for Preemies and Infants

All babies, but preemies especially, are inveterate problem solvers and they are bored. Watching the movement of their eyes, gives clues and strong understanding to what their brains are doing as, at first, they seek out bold and well defined shapes. They outline the shape and then begin to compare it’s parts. Within this framework, you can invent games to interest and challenge them.

The second 2 cards, part of the Ross set, were designed by a pediatrician, Dr. julio C. Guerra, and provide preemies with hours of fascination. Watch as the baby outlines each part of the round design and then compares it to the reversed color. Then, when the baby is asleep, turn the card so it’s now slanted and watch his eyes when he wakes and first sees it. We are all born with the same facial expressions and these babies do the classic ‘double take’, frowning, tilting the head, chin out to get closer… Watching hundreds of preemies, (some not supposed to be born for another 3 months). I began to time their concentration and was astonished to find it lasting from 12 to 28 minutes.

Make up your own games with these cards but keep them as simple as you can. Get colored stickers of dots and, while the baby is asleep, put one on the checkerboard card. Later, add another colored dot partially covering the first. Then watch.

It’s important that the cards be positioned straight up and down. Tipping them or turning them to the side will add the element of perspective which would change the experience.

The third and fourth cards below are part of a pack that Ross Labs, makers of Enfamil formulas gave to NICUs long ago. These cards were a huge gift to the  babies, A HUGE GIFT  but were discontinued for some reason.  

Please write to Ross Labs to reinstate their pack of cards, preemies need their intellectual stimulation. They were the very best and should be easily available for all babies.

Why are preemies problem solvers to a greater degree than full term newborns? It’s because they quickly become super alert survivors in extremely complex, annoying and stressful circumstances, and act in their own best interest like all of us, going toward pleasure and away from pain. The full term baby is comforted with basic needs met and soft human connections made and never has to develop skills to mitigate stress.

Open fullsize and print
Open fullsize and print

© Brie Widmeyer, CCRN

Open fullsize and print
Open fullsize and print

© Julio C. Gurrea, MD

Preemies Fail Hearing Tests. Don’t Worry.

The very young, very small preemie is initially put on an open warmer with full exposure to the noises around him.  Observing, one understands that even a 26 weeker quickly learns to tune out external noise, starting with the monitor alarms.  They will react only to sudden, very loud, unexpected noises and these should be avoided at all costs.  They also, with a strong connection, react to the voices of their parents which is the way they recognize them.

I have seen many hundreds of parents being told that their baby failed multiple hearing tests and it was completely wrong information… with disastrous results.  Because she believed that he could not hear, the mother would stop talking to him and because she was not talking to him, she no longer looked at him.

Therefore, the baby was no longer seeing the mother’s face or hearing her voice.  No more twinkling eyes looking at him, no more movement of mama’s head, no more little air kisses from her, no more little love words. He now only sees the bottom of her chin as she sits in silence. And he thought he had done something to cause this.

The young mother of fragile twins was crying and beside herself when I got to work one night.  One of the twins had failed several OAE tests and finally the ABR.  They told her he was deaf.  I told her I’d watch him during the night and to go home and sleep.  I called her at one in the morning and said not only was he not deaf, he knew his name.  I’d fed him twice and did an experiment to test his hearing  at least thirty times.  Each time I’d wait till his eyes were turned away from me and I’d call his name.  He’d look at me.  Nine times out of ten.  He is 13 today and certainly not the least bit deaf.

The medication Gentamycin has a strong hearing loss component as do some infections and very, very extreme jaundice, a rarity.  So why tell hundreds of families that their baby is deaf when it’s not even 3 pounds or verbal yet?  Ask the question:  “Who benefits?”  I believe it’s from lobbying for state laws mandating hearing tests of newborns by an industry that needs money. Certainly multiple hearing tests of these infants is not doing the baby any good or the family.  It’s harming the family for useless information.  Every mother will know if she has a deaf child by the time he’s 3 months old (corrected age). Then it’s time for hearing tests.



Pacifier for a Weak Chin

The Nuk Sager pacifier was designed as an orthodontic tool to bring an infant’s chin out and it works like magic.  When my children were infants in the 60s, we had to send to Germany for them.  Now they are in your local store.

The strange design brings the bottom jaw out and the curved plastic of the frame seats the pacifier firmly against the mouth as the baby sucks, creating a perfect  system.  This pacifier also brings the bottom jaw and the tongue forward to open the airway for infant stridor… the loud breathing that some newborns with weak chins have.  No other pacifier style brings the jaw forward!

Holding the baby with his head supported and neck straight is also important for keeping his airway open.  

The three women below were born with almost no chin, a characteristic of both sides of the family.  The Nuk Sager pacifier puts strong pressure on the muscles of the jaw, bringing it out in a normal position.

 

Co-bedding Twins

Two of the smallest twins and the first we ever co-bedded. I took their clothes off and we put them face to face, they looked at each other and began touching each other… faces, bodies. They had thought they lost their other. After that, I began to tell parents of twins to bring a video camera before they co-bedded the first time.
Thanks Amy. They are lucky to have you for mother. Beautiful.

 

Grade 2 Bleeds -IVH

Success stories from our NICU:

26 week twins,  fragile and sick, one with a grade 2 bleed are now 13 and full of it, perfect, in robust good health and both A students.

One of our 24 weekers had two grade 4 bleeds and she was High School Valedictorian.

About the IVH… this small bleed does not displace ventricular fluid and when the baby is adult size, if it’s still there, it’ll be a harmless little tag the size of a tiny pea.

Soothing a Preemie

The main thing parents can do to soothe their preemie is give them that comfort that only they can give. They know your voices. When you are there talk to your babies. Tell them about the people in your family. Read little books to them. Look deeply into your baby’s eyes and tell him he is beautiful and strong and will be a tall, handsome man, tell that you will take good care of him and he will have fun and run like the wind. Tell the girls that they are beautiful and will have babies of their own some day.

Science has recently learned that the fetus has a third language center in the brain… it’s function is to learn  language. This area begins to shrink at the age of about 7 but is now one of the most active parts of his brain. Therefore he knows your voices, he heard them in utero and recognizes them instantly. Reconstructing the comfort of the uterus soothes him.

The other thing is touch. The inclination of every adult with an infant is to touch with feather-light strokes… something that irritates most adults  and certainly irritates babies.  I’d put my hand firmly on the parent’s arm and say, touch him like this and they’d look at me in shock. I reminded them that the baby was packed into a very tight, confined space with firm pressures everywhere and that he likes that. Firm pressure, without moving the hand comforts.  Tickling feathery movements on the baby’s skin is irritating.  And never, never tickle the feet.

And, of course the music of PACIFE. There are no unexpected changes in this music. PACIFE was composed on a keyboard and then reworked to fit the 60 rules learned from watching babies monitors as they reacted to the sounds. Then adding some of the mathematical characteristics of Bach and the primal tunes idea of Bernstein gives babies comfort.

And wait until you and your baby get to do ‘Kangaroo Care’. Bliss for him. Bliss for you.

Preemies are survivors, they are very smart and sure of themselves. As children they are brave and daring. They are great with strangers, happy and excited about every little thing.
Remember that for them, everything just keeps getting better.