I agree with Laurie that this baby should just get fed in the most 
pleasant way possible, and given lots of skin to skin and TLC so he can 
recover from the intrusions of NICU life. And that mom really needs a 
hospital grade (metal piston) pump. The suction curves are smoothest for 
these metal piston pumps, and that's most likely to be most helpful for 
her right now.

I would also help her to make the baby in charge of anything entering 
his mouth. Mom can just gently touch the bottle nipple across his lips 
(with the top of the nipple touching his philtrum, the ridge between 
nose and mouth) until he opens up wide. This is also good practice for 
the wide gape one needs at breast. Then she can tip the bottle into his 
mouth. She can hold baby sidelying for bottle feeding, right near her 
bare breast, so he gets used to being there for food.

Is this baby truly hypertonic (muscles so tight it's hard for him to 
release them for use) or is he arching in frustration or from stress? 
There is a difference, and the "treatment" is different. If the baby is 
showing arching behavior when placed at breast because he doesn't know 
what to do there or is pursing his lips to say "keep out of my mouth", 
that's a functional communicative behavior and is very different from 
having a neurological injury that causes the brain to overactivate and 
stiffen the muscles. If the baby is really hypertonic, he needs physical 
therapy to help with positioning to help change the maladaptive muscle 
use patterns and support his brain's recovery to the degree possible. 
There are some preparatory handling techniques that could help in either 
case, such as swinging him gently in arms or in a blanket from head to 
food (through the spine) until his flexion increases. Hip flexion 
(having his legs bent around mom's side) can decrease arching behaviors 
and help interrupt hypertonic patterns, but you can't just force him 
into flexion.

Catherine Watson Genna, IBCLC  NYC

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