WORKSHOP Q & A: FEEDING ISSUES IN SUBSTANCE EXPOSED INFANT
Published by Dr. Joy Browne on Aug 20, 2018
Feeding Matters: What are the three main take away points that you want people to leave with after viewing your workshop?
Dr. Browne:
- Substance exposed infants have a wide variety of challenges in physiologic, motor, state and interactive regulation that impact feeding experiences and outcomes. Comprehensive individualized assessment and support are necessary.
- Mothers experience a range of reactions to seeing their babies suffer making it important to recognize that intervention during these “sensitive periods” in parenting can make a huge difference in the baby’s outcome.
- Mothers need extra support to understand the complexities of feeding their infants whether by breast or bottle. Breast feeding is likely the most appropriate method of feeding a substance exposed infant.
Feeding Matters: Can you share a little bit about how to approach complex feeding challenges?
Dr. Browne: I typically start with a good assessment of the baby’s behavioral communication in all areas that impact the feeding experience. This means taking into account all of the systems that are affected, especially during feeding. I include the mother as much as possible, not only finding out how she perceives her infant’s behavior, but also what she is thinking about her contribution to the situation. The best approach is to keep mothers and babies together so that the mother learns to understand the experience of the baby and has opportunities to be seen as a successful parent. In addition, both mother and infant undergo individualized medication and behavioral interventions, as prescribed by the medical or primary care provider.
Feeding Matters: We received some questions about anti-depressants and/or psychiatric medications. Are there contraindications for using these medications?
Dr. Browne: This is out of my scope of practice. I would recommend referencing the Substance Abuse and Mental Health Services Administration’s Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants.
Feeding Matters: The case below was shared by a parent in our feeding community. Can you answer her question, “Should I continue to introduce the bottle even when my child refuses?
Case Information
I have a former 24-week gestation infant that has trouble breathing and sometimes requires oxygen. When we try to offer the bottle, she is unable to latch. A majority of her nutrition is through her G-tube.
Dr. Browne: This is a complex situation that will need further exploration of all the factors that have contributed to this baby’s eating experience. I would recommend a consultation with a feeding specialist who has extensive experience with fragile babies. You can get in touch with some excellent professionals through Feeding Matters who can consult on this particular case.
Feeding Matters: Are there any resources or groups where therapists and other healthcare professions can get together and consult on difficult cases?
Dr. Browne: Erin Ross CCC, Ph.D. is the President of Feeding Fundamentals. She is very knowledgeable about feeding high risk infants. You can contact her at Feedingfundamentals@gmail.com to see if she might provide some case consultation.
Feeding Matters also has a number of interdisciplinary professionals who may be able to provide consultation for individual situations and cases.
Anyone interested in joining a community of caregivers, professionals and community partners aligned on providing support and advancing the system of care for pediatric feeding disorder is encouraged to join the Pediatric Feeding Disorder Alliance (PFDA) at https://www.feedingmatters.org/pfd-alliance/become-a-member/#wpcf7-f1406-p1399-o1
Feeding Matters: Do you have some good resources for getting the assessments you mentioned during your presentation?
Dr. Browne: I do.
Suzanne M Thoyre;Catherine S Shaker;Karen F Pridham ISSN: 0730-0832 , 0730-0832; DOI: 10.1891/0730-0832.24.3.7 Neonatal network : NN. , 2005, Vol.24(3), p.7-16
Browne JV, Ross ES. Clin Perinatol. 2011 Dec;38(4):731-43. doi: 10.1016/j.clp.2011.08.004. Review.
Ross ES, Browne JV. Semin Neonatol. 2002 Dec;7(6):469-75. Review.
Feeding Matters: Can you share links to the research/data mentioned during your presentation, specifically regarding the gastric emptying slide – timed feeding and emptying/sleep pattern?
Dr. Browne: Yes.
Nils J Bergman ISSN: 0803-5253 , 1651-2227; DOI: 10.1111/apa.12291 Acta pædiatrica. , 2013, Vol.102(8), p.773-777
About Joy V. Browne, Ph.D., PCNS, IMH-E (IV)
Joy V. Browne, Ph.D., PCNS, IMH-E (IV) is a Clinical Professor of Pediatrics and Psychiatry at the University of Colorado School of Medicine. She holds dual licensure as a Pediatric Psychologist and a Clinical Nurse Specialist. She is Director of the Center for Family and Infant Interaction, a component of JFK Partners, Colorado’s University Center of Excellence for Developmental Disabilities. She also is the director of WONDERbabies which provides training in the BABIES and PreSTEPS Model, the Family Infant Relationship Support Training (FIRST) programs and the Fragile Infant Feeding Institute. She is a Newborn Individualized Developmental Care and Assessment Program (NIDCAP) Master Trainer and an Assessment of term and Preterm Infant Behavior (APIB) trainer.
Her area of expertise is in neurobehavioral assessment and intervention with high-risk infants and their families, as well as systems change toward developmentally supportive and family centered care in both hospital and community settings. Dr. Browne developed BEGINNINGS, an interim Individualized Family Service Plan for newborns with special needs. She is a Zero to Three Graduate Fellow, founder and past president of the Colorado Association for Infant Mental Health, and a Board Member for the Alliance for the Advancement of Infant Mental Health. Dr. Browne serves on the Medical Professional Council for Feeding Matters.