Sucking is an important milestone for any baby and it starts to develop as early as the twentieth week of pregnancy, while the baby is still in the comfort of the womb7. Sucking is important in the development of feeding7, organising behaviour (improved alertness) as well as speech and language development.
Sensitivity around the mouth area develops in the womb from as early as 8 weeks gestation (weeks pregnant). This is one of the first systems to develop and indicate the importance of the mouth in survival. The baby can suck from 24 – 28 weeks and coordinate her suck-swallow and breathing pattern from 28 weeks gestation1,2. When born preterm, the baby may struggle with the coordination of suck-swallow and breathe and this may lead to choking when feeding is started too soon. In order to support the development of sucking and preserve the sucking reflex in the preterm baby, it is important to provide the baby with a appropriate sucking opportunities, which may include suckling on the mothers breast (or an expressed breast in the case of a tiny baby), sucking on her own thumb, hand, or lips or sucking on a pacifier7.
For preterm babies younger than 32 weeks gestation a pacifier should be selected that is similar to her thumb, since this it what she would be sucking on when still in the womb, but for a full term baby you can look for a pacifier that is similar to mom’s nipple3, 7. The general guidelines for a pacifier is that it should be shaped cylindrical in order to enable tongue-cupping. (this is the tongue forming a groove in the middle of the tongue in which the pacifier will be placed4).
When baby then feeds, she will be using the same technique, and this enable her to move the milk from the front to the back of the mouth (via the groove) and prevent her from spilling. Furthermore, the pacifier nipple should have a small bolus on the end to stimulate the soft palate and also the feeling part of the brain (the limbic system)7. This in turn stimulate the release of endorphin's or “feeling good hormones” which calms the baby.
The optimal length of the nipple can be determined when putting your finger into the baby’s mouth and allowing her to suck on it5, 7. Mark the position on your finger where her lips close and when you take your finger out you will be able to see how long the nipple should ideally be. The mother’s nipple lengthen and shorten continuously during a feed and the pacifier cannot do the same. Care should therefore be taken to select the optimal length, since a nipple that is too long may cause an overactive gag reflex and a nipple that is too short and flat may cause the baby to push the nipple out of her mouth and may also hinder the development of certain sounds and feeding7. Sucking also has a direct effect on language development.
The pacifier should furthermore have a big, soft mouth shield to stimulate and wake up all the nerve endings around the mouth and help with lip closure. The pacifier should preferably be a single unit that has no parts that may come apart and cause choking7. Finally the pacifier should have a handle which the baby can hang on to, since this will support the hands-to-mouth and mid-line positioning. Hands-to-mouth (or face) is a method the baby use to self-soothe and mid-line positioning is used for self-regulation, but also for supporting integration of left and right brain functions.
Cylinder shaped nipples to support tongue cupping (similar to thumb or mom’s nipple) Small bolus at end of nipple to stimulate limbic system of brain Optimal nipple length to reach ridge between soft and hard palate Big, soft mouth shield to stimulate nerve endings around the mouth “Handle” on shield to provide for hand-to-mouth and grasping.
When painful procedures, such as immunizations need to be performed the baby can be provided with a pacifier or mom’s breast two minutes before the procedure and additional sweet tasting substances such as mother’s milk or sucrose can be given two minutes before the procedure6. The taste system develops very early in pregnancy and is an important sense that is used to block painful stimuli and help the baby to return to a state of balance as soon as possible and with using as little energy as possible.
Research has shown that all different kinds of pacifiers has a similar outcome on orthodontic development of the child at five years of age, but by not using a cylindrical shaped nipple or teat, she may experience problems with feeding and language. Breastfeeding are however still superior to bottles teats and pacifiers when you want to ensure the best orthodontic development for your little one. Your baby should also be offered a pacifier when she is crying and struggling to settle, but she should not be using a pacifier after 14 months of age. However, if she does not want to take a pacifier, no need to worry. Only allow her to suck on your breast, since this will support the best mouth development. When your breast is not available mom or dad’s finger will be a great replacement. Providing your baby with a pacifier to suck on when you put her to bed, will also lower her risk for dying of cot death.
What about pacifiers in a Baby Friendly environment?
Baby Friendly is an initiative that was developed for moms with healthy pregnancies, healthy vaginal births and healthy babies who are not separated from mom after birth. If you do not fit all of these criteria, then your baby may need some support with sucking and if the baby is in the neonatal intensive care unit and does not suck for a period of time, she may loose the suckling reflex. Sucking confusion is also only seen when the incorrect kind of pacifier are offered, but by following the guidelines above and only using a pacifier when really needed (preferably only starting after 3 weeks), you will not have a problem with nipple confusion due to the use of a pacifier.
Sucking is important, since it supports normal development, self-soothing and let the baby feel good. In preterm babies it also prepare the babies for feeding per mouth and help them to feed better, grow better and even balance blood sugar levels.
by Wema Lubbe
REFERENCES 1. Breastfeeding and Human Lactation. Riordan, 2005:83, 85 2. Uys, KJ. 2000. Oral Feeding Skills of Preterm Infants. Master’s Dissertation in Communication Pathology. University of Pretoria. 3. Prematurity – Adjusting your dream. 2008. Lubbe W. Little Steps, Pretoria. 4. Wolf, LS & Glass, RP. 1991. Feeding and Swallowing Disorders in Infancy: Assessment and Management. Tuscon, Arizona: Therapy Skill Builders. 5. Wilson-Clay B, Hoover K. 2008. The Breastfeeding Atlas. Lactnews Pr, 206p. 6. Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd. 7. Engebretson, JC, Wardell, DW. 1996. Development of a Pacifier for Low-Birth-Weight Infant’s Nonnutritive Sucking. JOGNN. August. 26(6), 660-664
There is a direct link between maternal (mothers) health and the long term health of her baby. Both mothers who are obese and mothers who are severely underweight increase the risk of complications both during pregnancy as well as post birth. A mother that enters a pregnancy with chronic obesity is at a high risk of developing diabetes as well as having a baby that is extra big for his gestational age.
As the study from Pittsburg university points out, the link between infant death and the mother’s weight is correlated to some degree. Other similar studies have called this the 1000 day metabolic set up. This means that in the first 1000 days of a child's life - conception to the end of the toddler years will establish a child's metabolism as well as predisposition for developing lifestyle diseases later on in life like type two diabetes, hypertension and obesity.
So here are four golden rules to ensure you give your child the best start in life:
1. Prior to conception aim to reach a healthy body mass index (relationship of weight to height)! Do this by:
Choosing real, unprocessed foods, lots of fresh vegetables, raw fresh seasonal fruit and nuts, and seeds.
Choose high quality organic protein foods, eggs, chicken, fish and lean red meats are all good options
Incorporate healthy fats like avocado, coconut fats and olive oils.
Drink fresh water and herbal teas
Limit sugar intake and treats to once a week.
2. Relaxation and time out. Life is so busy and fast. Take some planned time out from the rush of life. Switch off cell phones and social media.
3. Get enough sleep - aim at 7-10 hours per night. Everyone is different and has different sleep requirements, whatever yours are you will know you have had enough when you wake up feeling rested.
4. Spend time in nature and being creative. This goes a long way to a healthy and happy mind and soul.
Points 3-5 are not directly nutrition related but research shows that people that have these in place tend to choose healthier, more natural foods. When we manage our stress, the body decreases the secretion of adrenalin and thus less insulin is produced which helps lower risk of metabolic syndrome (a leading cause of obesity, diabetes and infertility)
To conclude, pregnancy is no longer a license to eat for two but rather an awakening of and desiring to nurture and love one’s body by choosing healthy, natural and unprocessed foods. '
Kath Megaw - paediatric dietician and co-author of Feeding Sense
Your baby’s lungs and brain are beginning to mature and if you had a peak inside, you’d be able to detect some brain activity. It’ll keep getting more complex every day. Your brain is probably also working overtime, with so many thoughts playing on your mind – how will the labour go? Will I be a good mom? How will I know what to do? Will I be able to afford everything? This anxiety is completely normal, but try and take time out to process your thoughts. Also take a moment to appreciate that if your baby was to be born this week, it would have a good chance of survival (although it would require a considerable amount of time in the neonatal intensive care unit).
Your baby is the size of a sweet potato, weighs in at approximately 880 grams and is about is about 37cm long from top to toe. Your little button is now sleeping and waking at regular intervals, sucking her thumb and opening and closing those little eyes. You may also feel your little one hiccup occasionally. Your baby practicing their breathing techniques in preparation for the big day when they get to test those lungs for the first time.
Just when you think no more pregnancy symptoms could possibly exist, insert leg cramps (and that’s over and above the now everyday symptoms such as heartburn, back pain, a stuffy nose, ligament pain, snoring, and itchy skin). The extra weight you’re carrying, and the growing uterus is putting pressure on your veins that return blood from your legs to your heart. Sadly, these cramps may worsen as your pregnancy progresses. They often seem to strike at night, so try and put your feet up as much as possible during the day.
Remember to pre-register your birth with your medical aid so that you can receive a medical aid number.
Congratulations! You’re on the home stretch. No one said running an ultra marathon was going to be easy, but crossing the finish line will make it all worthwhile. There’s no denying that this last stretch is the toughest one both mentally and physically. By now, just about every ache and pain one can expect during pregnancy is in full swing and you’re probably growing more uncomfortable by the day. Both you and your baby are gearing up for labour. Your breasts are starting to produce colostrum and your little one is practicing breathing techniques.
Your baby is now the size of an cauliflower, and weighs around 1kg and measures about 38cm. Your baby is almost ready to enter the big world and most of the lanugo is starting to fade. Just about everything is developed and functioning. The next 10 weeks will be spent fine-tuning everything before their birthday. Your cherub is also plumping up and smoothing out that wrinkly skin. Their lungs are also maturing everyday in preparation for life outside the womb.
As your body begins to prepare for labour, you may start feeling more frequent Braxton Hicks. Your breasts may also be in overdrive, so don’t be alarmed if they leak occasionally while they “test” out their new up and coming role. You will also be gaining around a pound per week this trimester and you may start visiting your gynae every second week for a general check up.
If you’re having a boy, now would be a good time to chat to your partner about circumcision. Sometimes religious beliefs make the decision for you, but this is very much a personal preference that should be made together.
Take a photo of your growing bump so you can compare your growth from just four weeks back.
Your belly is growing daily, and chances are you’re struggling to see your toes over that bump. By now your little champion has perfected the Karate Kid kick and you can feel him move around. You can probably also start getting a good sense of when they’re having a snooze and when they’re awake. Have you started counting your baby’s kicks? It’s important that you count them everyday. You should be experiencing 10 movements within an hour or two. If you don’t, have a light snack and wait for the sugar rush to kick in which should spike movement. However, if you feel that movement is less than it should be, do not hesitate to call your doctor. They may just be having a lazy day, but it’s much better to be safe than sorry.
Your bay is now weighing around 1.14kg, about the size of a broccoli (no wonder you can’t see your toes when standing.). Your baby stretches out about 39cm long from head to toe. At this stage, your little one is continuing to fatten up, and allowing their muscles and lungs to mature. Their head is also growing bigger to make way for their enquiring mind. The skeleton will also harden this trimester, which means 250 milligrams of calcium will be deposited into their bodies daily to help this process along, so be sure to drink your milk moms!
Along with the usual aches and pains, you may also be developing varicose veins. They pop up because of the increased blood volume during pregnancy, coupled with your growing uterus putting pressure on your pelvic veins (and lets not forget relaxin which is causing your veins to chill out a bit). They’re fortunately not harmful to you or your baby, but we understand you may be feeling down about their appearance on your once gorgeous and perfectly smooth legs. They should fade once your little one is born.
Make sure your bags are packed for the hospital and that the nursery is just about complete.
You should be planning your baby shower over the next weekend or two (don’t leave it for too much longer).
Your baby is growing daily and you’re probably wondering how it’s possible that your belly is going to expand anymore than it already has to accommodate this little person for another 10 weeks! And to top it off, the list of pregnancy ailments just keeps on growing. Heartburn is probably burning a hole in your chest. And your expanding uterus, which is putting increased pressure on your stomach, only makes matters worse. By now you most likely finding it impossible to sleep with your belly in the way of a securing a remotely comfortable position.
Your little one is now the size of a cucumber, and weighs in at a healthy 1.35kg. Your baby plans to pack on the weight by about 200g per week for the next 7 weeks. Your baby’s skin is getting smoother, and their brain is developing more with each day that passes. They will now be strong enough to grasp your finger too. You’ll definitely be feeling more definitive movements, you may even be feeling their limbs move about.
Round about now you’re probably starting to feel baby bump fatigue … Quite simply, you’re getting tired of lugging this massive ball around. Having every pregnancy symptom thrown at you from heartburn and increased urination to swollen feet, isn’t making the situation any better. Frankly, you’re exhausted – and it’s totally understandable. Be sure to put your feet up regularly and drink lots of fluids. It’s not too much longer now.
With increased swelling over the next few weeks it would be wise to remove your rings. Those once lean fingers are very quickly becoming porky pies and your rings could cut off circulation.
Get all documents in order for birth registration, which can sometimes be done whilst in hospital.
Make sure you plan a visit around the maternity ward and familiarize yourself with the surroundings that will become home for a few days.
Start packing your hospital bag with the essentials that you will need for the big day.
Can you believe that your little one’s senses are all fully functioning. They can touch, see, smell, taste and hear everything that’s going on in their little world. You may start to feel very short of breath at this stage – as the rounder you get, your stomach feels like it’s squashing your chest, and your chest feels like it’s squashing your lungs. This is because your uterus is taking pride of place, and pushing all your internal organs somewhere else. This means your body is squeezed on air. But you can take a sigh of relief (a small one), because your little one is as happy as a kid in a candy store, they’re getting all the oxygen they need from the placenta.
Your little baby is about the size of a lettuce, is just 41cm long and weighs anywhere between 1.4 - 1.6kg. They’re almost at full birth length but still need to get a little chubbier before due date. Their home is starting to become a bit cramped which means they can’t move around as freely as before. This gives them a good excuse to catch up on a few zzz’s – you may notice definite times of movement versus sleep. If you’re wondering what your baby is doing all day when they’re awake, they’re most likely sucking their thumb, swallowing, breathing and giving you an occasional nudge.
Yip you guessed it, all those unwelcome pregnancy aches and pains are still there, but the one that may be getting you down the most is sleep … or lack thereof. With a large bump, leg cramps, heartburn, frequent urination and shortness of breath, you’re probably finding it really hard to get comfortable. Sadly, there is not much you can do about it, but try and prop yourself up so that you’re sleeping a little more upright.
Discuss your birth plan with your gynae. Remember to write this down so on the day there’s a record of it if ever required. Make a few copies, which you can give to the nurse on duty when you arrive at hospital and to the doctor on duty.
By now you’re physically exhausted and ready to have that baby. But it’s not long to go now – just eight more weeks. At this stage your baby should be getting ready for birth, and should be turning into position with their head down (fewer than 5% of babies remain breeched, which means that their head stays near the top of your stomach). They’re slowly starting to get ready their grand entrance!
Your little coconut still around 42cm and weighing about 1.7kg. And as their living conditions become more cramped, their movements also become more restricted. You’re probably gaining around 450g a week and over half of that goes to your baby. Interestingly, your baby will gain about 1/3 of their birth weight during the next seven weeks – they fattening up for the real world. Your cherub is also proudly showing off fingernails, toenails and hair and their skin is beginning to smooth out as they plump up.
With your growing bump squashing all your insides, you may be surprised to find that your appetite has decreased. This is accompanied by shortness of breath and heartburn. If your tummy is tightening at random times during the day, you’re experiencing Braxton Hicks and they may becoming more frequent as your body preps for labour. They usually last around 15 to 30 seconds. You may also notice that your nipples have become much darker. This is your body’s amazing way of creating a target for your little one so they know exactly where to go to feed.
Make sure your medical aid is covering all expenses – find out what they do and don’t cover.
Take a photo of your growing bump so you can compare your growth from just four weeks back.