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When your baby is first born, they will be unable to feed until they have had their corrective surgery and recovered sufficiently. During this time, they will be given fluids and nutrition intravenously, containing all of the nutrients they require to grow and heal. The length of time until your baby has their corrective surgery will depend upon the type of OA/TOF that they are born with.
Most babies are born with “short gap” OA/TOF, and undergo a primary repair within the first few days of life. All being well, these babies will then be able to begin having small feeds of their mother’s EBM in the days that follow, via a tube known as a TAT (trans anastomotic tube). This is a tube which is inserted via their nose into their stomach and not only helps with feeding, but also prevents the healing tissues of the oesophagus from closing over. They will then progress to feeding orally, which can involve transitioning to breast or bottle feeding, once ready.
Approximately 10% of OA/TOF babies are born with “long gap” OA. These babies have a gap between the upper and lower ends of the oesophagus which is too long to be repaired straight away and therefore corrective surgery must be delayed for weeks to months. During this time, they will be able to receive their mother’s EBM, and the many benefits that doing so has to offer, via a gastrostomy feeding tube inserted into their stomach until they have grown enough to have their corrective surgery. It may also be possible to offer “sham feeds”, a process which involves a baby feeding orally, via a breast or bottle, and then suctioning out the swallowed milk from the upper oesophageal pouch (The Royal Children’s Melbourne Hospital, 2020).
This method allows babies to develop their suck and swallow reflexes and learn how to feed orally, readying them for breast or bottle feeding once they have had their corrective surgery (Golonka & Hayashi, 2008).
More information about sham feeding can be obtained from your baby’s surgeons, NICU team and speech and language therapists (SALT), who will be able to advise if this is an option for your baby.
Progressing onto breastfeeding can be particularly challenging for long gap OA babies and mothers, but it does not mean that it is impossible. If this is something that you would like to do, with the correct support and motivation, this may still be achievable.
