In a message dated 1.23.04 8:32:49 PM, June writes:


> I looked after a mum and baby yesterday.  when i checked the feed chart =
> I noticed that the baby hadnt successfully latched at the breast since =
> the first feed after delivery.baby was just coming up to 24 hrs old. =
> born by emergency section for small pelvic inlet
> Mum stated that baby was sleepy, and lethargic throught the day.
> When baby  was woken for feeding he went to the breast he was =
> keen,opened wide, latched but slipped off at each attempt. The nipple =
> never looked elongated.
> with mums permission I did an suck assessment and the tongue curled =
> around the tip of my finger.
> I introduced a nipple sheild in the hope that the baby would have to put =
> his tongue down to suck. Mum had very little colostrum.so we hand =
> expressed the smallest amount of ebm and gave by spoon.
> What could I have done instead of the nipple shield. can anyone =
> recommend any books  or techinques that would be useful for a new =
> lactation consultant to use.
> 
> Thankyou for your support and replies.
> 
> 
> June Nicholls
> IBCLC
> 
Hi June,
As you well know, a newborn is normally sleepy and lethargic within the first 
couple of days. Assuming he is a healthy, good sized newborn there is no need 
to worry about his intake at this time (24 hrs). Use of expressed colostrum 
is always a good idea however, even if only to stimulate his interest.
 I   would not use a nipple shield at this point, in fact I *might* want more 
of an indication to put my finger in this baby's mouth at all -it would 
depend on the circumstances ie. was Mom using sts (skin to skin)?, was there an 
oroboobular (ha, ha?) issue.   Why? Putting your finger in a baby's mouth before 
a successful latch has EVER been achieved *may* have a negative consequence 
and what is the benefit? You need to weigh that. IME, simply knowing that the 
baby curls his tongue at that moment in time tells you nothing. He has never 
latched thus all of the learning that takes place with that experience has not 
occurred. This isn't to say that I never put my finger in the mouth of a never 
latched newborn, in fact I did it twice yesterday!   Why NO to a nipple shield? 
  TIMING-1. he is too young ie. he hasn't been given enough of a chance to 
learn
2. he has never latched-do we want his first time to be patterning to a firm 
piece of plastic. 3. not enough milk-the simple fact is shield use can be 
tricky even in the best of circumstances-full breasts are generally a necessity 
for milk tranfer and if the baby isn't getting anthing -the risks far outweigh 
any benefit. 
What to do differently? In my institution it is ALWAYS fair to assume that 
there has been little or no sts -so I'd start with that. I physically put the 
baby under Mom's hospital gown   make them comfie and tell them i'll be back in 
a few hours-if baby appears interested p/t my return-start without me!   If 
latch continues problematic I will sometimes use larger volumes of dripped milk 
(either EBM or formula) on the nipple to incite. Often hand expressed drops of 
colostrum aren't as stimulating as the faster flow/cooler temperature?   (by 
pushing the bottle nipple to squirt mode-messy! ) this technique offers.   

Lynn Shea Rn,Bsn,Ibclc
Franklin,Massachusetts

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