Mary,
I once had a mom with an entirely different situation, but she already
had a fingerfeeder. When I saw that a shield might help, it was a simple
matter to run the smaller size tubing under the flap into the general
vicinity of the tip of the nipple, and simply squeeze the fingerfeeder to
bolus a small amount of supplement into the apex of the shield at fairly
regular intervals whenever the baby seemed to need more consistent flow
than he was getting. It was an easy interim solution till the main
problem was solved so that the weaning from the shield could start.

This mom seems to have an awful lot on her plate, what with temporary
move to a different household, toddler, pumping, etc. She still has the
same 24 hours a day she had when she had only one child. I often find
moms feel better understood when I empathize with them over how
frustrating it is when the toddler acts out their insecurity over the new
arrival. I explain what a normal reaction this is, partly to a sudden
decrease in the amount of touching, and that children will often
unconsciously resort to "getting mom's goat" if necessary, just to get
touched.

I explain that the skin is the largest organ in the body, and that
touching changes the brain chemistry. I suggest ways to "make deposits"
to fill the toddler's "touch bank" early and often in the day, e.g.
brushing hair, rubbing back, feet, etc. so the toddler has something to
"draw on" whenever mom is busy with baby. Sometimes it helps to "give her
permission" to let the baby cry for just a minute while telling the
toddler "I think you need some vitamin tickle!", and take 20 seconds or
so to gently tickle under the arms or the bottom of the feet, etc. so
they can have a good laugh together, then go to the baby. (Advice my own
mom gave me!)

It also acknowledges her dilemma of feeling torn over whether to tend
first to the toddler or the baby, to suggest that she try to turn feeding
time into a "party time" for the toddler, as in "Well, there's that baby,
hungry again! Now we get to have a snack and a story time again!" I'm
sure I must have learned this at some long ago LLL meeting!

Another valuable trick is to suggest that on days when the baby doesn't
really need a full bath, to make a big production of "promoting" big sis
by encouraging her to "give a lotion bath" (under supervision), massaging
from top down and center out, explaining this is the natural direction
for nerves to develop, and that both the little ones will experience
pleasureful stimulation from the touching, and that when the first
deliberate smile comes, it might be big sis that gets it, helping the
sibling bonding.

I'm sure you are frustrated, and concerned over the baby's well-being.
But when "compliance" with your recommendation is your goal, try to
remember that mom is operating on interrupted sleep, trying to "be
compliant" to her toddler's expressed needs as she now experiences them,
her relatives' view of the kind of a mother she "ought" to be within the
confines of their home, her doctor's "orders", and who knows, maybe she
is trying to comply with her husband's idea of what a good wife and
mother "should do"(managing home decorating projects at the time a new
baby has arrived), while at the same time trying to squeeze the needs of
the new baby and feeding complication into the same 24 hour time frame.

Sounds like you are in the perfect position to give her a few strokes now
and then for how hard she is trying to be a good mother! She is trying
hard to follow Rule #1: Feed the baby, and Rule #2, support the milk
supply. For now, that may be a struggle for her, and rule #3, "Fix the
breastfeeding" may have to wait for a while longer.

She has to be the one to make the final decisions about her priorities,
because it's her stamina and her 24-hour home-and-family managerial
responsibility. She, and she alone, is really the mom of those children,
for good or for ill. Just protect yourself legally by documenting your
observations and recommendations well, notify the doctor of any real
dangers you assess, and keep us posted on how you and she and the baby
work it out. What a challenge for you! Keep up the good work!

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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