Case Studies

1.  Danny S.  (Twin 2).  Date of Birth: September 12, 1986.  Birth Weight: 4lb 15oz.  Discharge Weight: 5lb 1ozInfant's particular difficulty with oral feeding: Bilateral cleft lip and palate.

Type of feed given: Expressed breast milk for approximately 5 days. Then milk dried up. From then until the present time fed on SMA Gold Cap. 
The method of feeding, prior to prototype feeder: a) Orogastric tube feeding. b) Prototype feeder offered (from second day).
Any noticeable changes in the degree of flatulence and regurgitation? Only occasional possetts on prototype feeder. When feeding 'enthusiastically' a little 'windy' at these times. Mother was using feeding on Dots 2 & 3, until Danny had a plate fitted last week. Now she feeds on Dot 2 as the flow is too fast for Danny at the moment on Dot 3.

Danny is now feeding very well on the prototype feeder - taking 120 - 130mls 4 hourly. (19/10/86) 730mls taken in that 24 hour period.

2. Shaun S.  (Twin 1) Date of Birth: September 12, 1986. Birth Weight: 4lb 15oz.  Discharge Weight: 5lb 1oz. Infant's particular difficulty with oral feeding: Unilateral cleft lip and palate (right side).

Type of feed given: Expressed breast milk for approximately 5 days. Then milk dried up. From then until the present time he was fed on SMA Gold Cap.

The method of feeding, prior to prototype feeder:  a) Due to difficulty in feeding - sucking by not getting anywhere - orogastric tube feeding.  b) Prototype feeder on Day 2 only - I was told it was dismantled for cleaning. The valve did not work after so this had to be discontinued. (Prototype not available prior to Day 2).  c) Newborn Teat with extra holes.  d) Lambs Teat x 2 feeds not successful.  e) Newborn teat with extra holes.  f) Used the above until two and a half weeks ago when the mother obtained a new feeder from Mandy Haberman. 
Comparison:  Conventional.  Example:50mls.  Took 1 1/2 hours to take. 
Struggling at times needed holes in the teat (almost like a pincushion) to be successful.  No previous babies to compare with for Mum.  Prototype
Example: 50mls.  Took 20 mins to take.  Took feed easily and quicker. Slower only occasionally.  Happy with the Haberman feeder because Shaun took much less time to feed, was less tired, less 'windy' and therefore settled better. Mum is very happy to have found a method of feeding which is quick and easy, particularly having two babies with a similar problem. She is relieved to have found a solution to such a difficult problem (applies to Danny also).
Any noticeable changes in the degree of flatulence and regurgitation?
  Shaun appeared to possett more often (approximately 10mls) on the conventional teat. This was probably due to having so many extra holes in the teat and taking in air.  He does also get 'wind' on the prototype feeder (uses Dots 2&3).  Since obtaining the prototype feeder two and a half weeks ago, Shaun has been feeding very well and is now taking 100 - 120mls 4 hourly. (10/10/86 695mls in that 24 hour period.)

Comment relating to the new prototype:  Mr and Mrs S felt these points were valid:-
They felt by removing the valve from the cylinder caused the feeder to weaken. Then it would not work properly. Mother felt it would be better to cleanse it with salt and flush through with boiled water without removing it.
Dots to signify the rate of flow. It was felt these were difficult to see. They could be coloured. Mrs S said if she was not wearing her glasses, she could not see them and had to feel for them. There was leakage from around the shank. If the top was screwed tighter the valve did not work - if loosened there was leakage from between the bottle top and teat.  Generally mother and father are happy with this feeder.

3. Elizabeth J. Date of Birth: July 2, 1986. Birth Weight: 4.225g (9.6oz) (normal delivery).  Discharge Weight: n/a.  Infant's particular difficulty with oral feeding.  Elizabeth was born with a hare lip and cleft palate.

The method of feeding prior to prototype feeder: Mrs J breastfed for a day or two but Elizabeth was unable to fix. She commenced bottle feeding on Cow & Gate Premium in hospital and was managing to take 50 - 57-mls per feed.  On her discharge home Mrs J commenced a feeding chart enabling her and community staff to keep a record of Elizabeth's daily intake. From 7th - 11th July she took the following amounts:-

7 feeds - total 415mls
6 feeds - total 393mls
6 feeds - total 365mls
6 feeds - total 338mls
6 feeds - total 338mls.

Elizabeth had been feeding via soft hospital teats supplied by the midwife but she was taking only small feeds and also becoming very tired. She had been seen by the orthodontist and supplied with a plastic palate. Elizabeth often pushed this out of her mouth but Mrs J was easily able to replace it.

On examination Elizabeth was a sturdy baby but still had not regained her birth weight of 9lb 6oz. On the ninth day she weighed 9lb 0oz. Her muscle tone and reflexes were good. Eyes, mouth and umbilicus were clean. Scriver and hyperthyroid consent was obtained and blood samples submitted.

Mrs J was coping very well but concerned regarding Elizabeth's weight and time taken to feed. She was hoping to obtain a prototype teat for babies with hare lip and cleft palate from Mrs Haberman.

12/7/86 Prototype teat obtained and Elizabeth commenced occasional feed as mother had only one special teat to sterilise. Elizabeth had been taking feeds from 30-80mls but a marked improvement was noted on commencing with the prototype teat and she was now able to manage a feed of 138mls.
From 12th to 19th July 1986 a gradual increase of feeds was noted.
6 feeds - total 368mls
5 feeds - total 453mls
6 feeds - total 440mls
6 feeds - total 445mls
7 feeds - total 470mls
5 feeds - total 370mls.

From July 19, 1986 the prototype teat was used at every feed and Elizabeth took 530mls of milk. When weighed on July 21, 1986, Elizabeth had regained her birth weight of 9lb 6oz. From then on Mrs J became more confident in using the new teat and Elizabeth was seen to feed very well. There was a noted improvement in her daily milk intake.

7 feeds - total 545mls
6 feeds - total 590mls
6 feeds - total 590mls
8 feeds - total 670mls
6 feeds - total 680mls
6 feeds - total 595mls
6 feeds - total 565mls
6 feeds - total 660mls
6 feeds - total 600mls
7 feeds - total 740mls
6 feeds - total 560mls.
Changed to Cow & Gate Plus:

7 feeds - total 700mls.
(Further impression taken by Orthodontist for new plastic palate)
6 feeds - total 685mls
6 feeds - total 655mls
6 feeds - total 710mls
6 feeds - total 655mls
6 feeds - total 600mls
6 feeds - total 625mls.
Elizabeth was now sleeping long periods at night and on August 14, 1986 weighed 11lb 6oz and her six week development assessment was satisfactory.

By September 15, 1986 Elizabeth was taking 230mls feeds and approximately 1000mls per day. It was decided to commence her on gluten free baby rice and introduce her gradually to a plastic weaning spoon.

On October 13, 1986 Elizabeth was admitted to hospital. She had an operation for repair of hare lip on October 15, 1986 and was discharged home on October 22, 1986.

After her return from hospital, she took a while to settle as her arms were splinted and also the Consultant thought she was teething but she continued to feed well from the prototype feeder.

Elizabeth is now nine months old. She is a happy, alert baby. She enjoys her breakfast and has cereal followed by an 8oz (240mls) bottle of milk taken via the prototype feeder. She has another feed from her feeder of 8oz (240mls) at night-time.

Elizabeth is sometimes in the care of grandmother who has been able to sterilise and assemble teats without any problems.

Health Visitor's point of view:
The only problem I considered was that the teat had no cover. Mrs J has overcome the problem of sterilisation by having a small portable Tupperware box in which she keeps the teat in a sterilising solution. I feel that the teat has given Mrs J the confidence to feed Elizabeth since she obtained it when Elizabeth was seventeen days old.  Elizabeth is due to have a repair of cleft palate between the age of eleven and fourteen months. I have encouraged Mrs J to attempt to give Elizabeth a cup but mother says at present she is much happier with the feeder.

4. Mark. Date of Birth: July 26, 1989.  Birth Weight: 3.51 kg.  Discharge Weight: n/a.  Infant's particular difficulty with oral feeding: Bilateral cleft lip and palate.

Type of feed given:
Initially Mark was fed on Cow & Gate Premium with a lamb's teat. Both mother and baby found this difficult and distressing, only 20mls being taken each time.  The method of feeding, prior to prototype feeder:
Most surprisingly Mark's weight dropped over the next few days to 3.09 kg. He was admitted to the special care baby unit, where he was first fed by nasogastric tube and then spoon-feeding was introduced. His weight increased by 130gms over this period.  By the time he was a week old, he was taking these feeds fairly well, managing 50-60mls 4 hourly. However, he appeared to gain no satisfaction from the method and his weight increased only 10gms over 2 days.  These feeds lasted approximately 1 hour. He regurgitated fairly substantial amounts of milk and suffered a great deal from flatulence.  Mark was discharged home after a further 23 days and a gain in weight of 30gs.

This method of feeding continued for 2 weeks, when Mark was fitted with a feeding plate. With this, he would take 100-120mls, 3-4 hourly but with the continuing disadvantages of regurgitation and wind. Feeds were still taken over an hour.

After a further week, the mother was made aware of the Haberman feeder, and she introduced Mark to it. He immediately started to feed with obvious enjoyment, taking 120mls plus in 30-40 minute. There was little change in the level of flatulence, but the amount of regurgitation was dramatically reduced. Baby Mark's weight increased apace.  The mother had a very worrying and anxious time whilst her baby was so hard to feed and not thriving. When Mark started to enjoy his feeds, her relief was immense.

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