No one is saying that it's good evidence, but it's a start.
The authors state that the major intervention in the implementation of 
the baby friendly hospital initiative was the removal of artificial 
nipples and the substitution of finger feeding in their institution.
One can never innovate if one never tries new practices. Fingerfeeding 
is based on research about tactile/proprioceptive processing, some of 
the tactile exercises already done in infants to help improve feeding, 
with the conditioning aspect of the provision of milk when tongue 
movements are sufficient to draw it.

A finger is different from a bottle teat because the finger is 
responsive, and can be used to help stimulate and guide tongue 
movements, even when a glove is worn. I will agree that fingerfeeding is 
NOT close to breastfeeding, but it does provide proprioceptive and 
tactile input that can be positive for the infant. Bottles work just as 
well if the baby chews the nipple or purses and contracts his lips as if 
the baby uses tongue peristalsis. Fingerfeeding by most methods allows 
the infant to get milk only by generating negative pressure through 
tongue peristalsis with posterior tongue depression, the same way the 
breast does. Compensatory lip movement does not bring milk in when 
fingerfeeding, neither does excessive jaw compression. Tongue humping 
and tongue retraction can be discouraged by changing the orientation of 
the finger in the mouth to provide counterpressure against the posterior 
tongue, with the reward of milk for working to keep the posterior tongue 
down, where it belongs. Can't do that with a bottle. (And I do use 
modified bottle feeding in my practice, and cup feeding, and 
supplementation at breast, and every other tool we've developed, as my 
clinical judgement and the parent's wishes dictate).

There needs to be a balance of potential risks vs potential benefits of 
any unproved treatment. If the potential risks are low, then the benefit 
need not be proven in order to try the treatment. Craniosacral therapy 
is a similarly unproven, low risk procedure that is well accepted by 
some that are critical of other interventions. I'd like to see our 
profession apply critical reasoning to all our procedures, and not be 
unduly prejudiced by either fads or fearmongering.
Catherine Watson Genna, IBCLC NYC

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