I wrote this article immediately after feeding Chester. I wrote it purely because I love the engagement involved in feeding a preterm infant – especially one who spent weeks wanting to eat, but was unable due to his significant respiratory issues. Once able, look out! This boy loved to eat. It was a pleasure and privilege to support his quick and steady advancement to full oral feeding.
This is Chester, on oxygen, his first or second feeding. He’s been working his whole life to breathe and is finally ready for the next step. He’s rooting now, hands to mouth, eyes open and searching, good tone, legs flexed.
I bundle him in his blanket, being sure to flex his hips well for feeding, place his hands in midline and toward his face. He pulls his hands so tightly against his face I can hardly get the nipple near his mouth. Chester roots at the taste of formula which I’ve given him in drops on his pacifier for the last several weeks.
He latches on but I keep liquid out of the nipple at first, knowing he has a strong suck and will take in a ‘big’ bolus with his eagerness and choke himself if the nipple is full. (Yes, even a slow flow nipple!)
I start by letting him latch on as he feels comfortable; slowly raise the nipple to allow the flow to gradually reach his mouth. He sucks 2 or 3 times eagerly, then his eyebrows raise, his eyes widen. I know this means stress and likely he is unable to swallow as fast as he is sucking. The extra fluid in his mouth makes him panic a bit. I pace him, tipping the nipple down, no fluid now and he is cued to breathe…pant, pant, pant….about 5 or 6 times.
When his breathing settles, I tip the nipple back up and he continues to suck. He gives me the eyebrow consistently every few sucks and the dance continues.
I watch his jaw drop as he pulls milk from the nipple, watch and feel him swallow. He is briefly apneic after just a few sucks, his prematurity showing in his lack of coordination. He is lying on his side on my leg with my hand gently cradling his head. I feel his breaths with every pause. I listen to his body and he tells me what he needs.
If people talk to me I only look up if he is pausing to breathe, otherwise without careful attention, he will choke, his heart rate will fall, and he will be easily overwhelmed. I feel responsible for helping him, for making it a good thing after weeks and weeks of not so great things. I watch how his lips form a seal around the nipple, how his little chest heaves in and out while pausing for breaths.
By the end of his feeding he begins to pace himself. He is less eager, hands now down by his side and he is losing his tone. I never once take my eyes off him.
I feel his great effort in these 15 or so minutes. He eats as if there is nothing else.
I appreciate his handsome little face, how he’s getting a little chub on him from weeks of careful medical and nutritional attention. I notice that his posture could be so much worse for a baby who has been so sick, but his nurses have kept him in great alignment. They have done this from the beginning, even when he was so small, making this another of their many priorities because they care about his development.
At the end of Chester’s feeding, I lay him on my chest and his body relaxes nicely there, content. His eyes are open, his jaw now slack and slightly open. I snuggle him in and tell him he’s cute and special and he did a great job, that I’m proud of him.
He may do this all over again in just a few hours.
And soon he will seek the dance. He will love the dance. I can tell.
