>Could baby be orally defensive from all that has been and is still in his
>throat???   If yes, how to overcome?? He tires easily due to his cardiac
>condition.  The doctors do not want him to cry or feed too long.
>I suggested  1. pacificer during NG
>feedings to associate sucking with feeling of full stomach 2. Lots of skin to
>skin contact, 3. Allowing baby to suck on mothers clean finger a few time a
>day, hopefully to open option of finger feeding if need be 4. Continue to
>offer breast and allow baby to lick, taste expressed milk.

All of your suggestions are great.  As an OT who has had a lot of experience
with these kids in the NICU, I think you are right on.  This little person
has just had MAJOR surgery and is bound to be pretty exhausted, plus he
has had a lot of negative oral experiences.  And he's not very big, so
he probably doesn't have much in the way of fat pads in his cheeks,
which go a long way toward helping babies be really efficient with sucking.
The fat pads stabilize the cheeks so you don't need so much muscle to
control the cheeks and they also just plain take up space, so the area
inside the mouth is smaller and it takes less "suck energy" to make
a decent vacuum to help with milk transfer.

I like to offer these infants a couple of different pacifiers, plus fingers
of different sizes (mom's, dad's) so that they don't "imprint" on just one
shape and size.  My hope is that they will learn that "something" needs
to be in the mouth in order to get that full tummy, but they won't be
particularly particular about what it is, which might make transition
to the breast easier.  Skin to skin during NG feeds is great, with all
the licking and playing he wants, expressed milk dribbled on the nipple,
etc.  Maybe a SNS during NG feeds, too, so he gets the idea of sucking
bringing him something interesting and encouraging that.  Or the SNS
first for a couple of minutes when he is really interested, with
the NG being started a bit later, just before he starts to fatigue.
That might help make that "sucking = full tummy" connection.  Hope mam
has help to control all those tubes!!

Good luck with him!  Keep up the good work!  And give it time - he really
must be pretty tired right now.  Sucking is hard, hard work.  After
major surgery, just "resting" is hard work, sometimes.  So take it slow
and keep his options open for him.

Sue Berres, OTR, PT