Yes, a tube at breast would be ideal for this baby, to teach him that 
milk comes from the breast and help him work a little harder. Some 
babies who "fall asleep" at breast are withdrawing due to frustration. 
Look at his little face to see the difference, a withdrawn baby looks 
tense around the forehead and/or eyes, a sleeping baby is relaxed.

You could use a feeding tube from the hospital (5 french or thinner) on 
your syringe at first, and give the baby tiny mouthfuls as he sucks, and 
then switch to a LactAid or SNS when mom returns home and baby has 
learned to work for his supper. I've had better results in my practice 
with the Lact Aid, especially for BFAR (bf after reduction) moms, though 
you can use whatever you can get your hands on.

Radial breast massage (massaging gently from the back of the breast 
toward the front in 10 or 12 sections around the breast) can help make 
colostrum easier to express. Joan Fisher has made a great video (very 
inexpensive too) on manual expression that shows this technique. I lent 
my copy to one of my interns, and don't remember the exact title, but I 
think Joan is on Lactnet. She's in Ottawa, Canada.

Good luck, it's always harder when the person you are trying to help is 
a friend or relative.
Catherine Watson Genna, IBCLC  NYC

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