Judy remarks about...<< baby getting AIM by syringe, vs EBM/colostrum by bottle? I am interested in professional and personal opinions about how choices are made >> I prefer to hold off on formula unless there is a medical indication for the infant needing to be fed (which, IMHO, is rare). but, since our nursing staff prefer to push formula despite our best efforts, I encourage the moms to insist on the baby being cup fed if she is convinced that the supplement is necessary (I also empower my moms to say to the nurse, "what did my pedi say"--at 2 AM, not too many nurses are going to call the doc unless they know it is a REAL medical problem). If mom/baby are to go home on formula due to MD orders, I evaluate the mom's ability to handle everything. I remind them how milk supply works, and how it can be hindered if the "breast" is not "told" about what extra stuff the baby is taking. I encourage offering the breast first at EVERY feed, then topping off with formula when the MD orders supplementation. If mom is not comfortable with cup feeding (esp if there is no latch problem, but supplementation recommended for some other isolated incident such as jaundice--common here), I will have them use a bottle with a nipple that encourages wide open mouth. I then teach them how to bottle feed "responsively", i.e. by watching the baby's cues and pausing the feeding after every 15 cc, to see if baby really wants more or is just swallowing due to the way a bottle works--a demo with a bottle works wonders in making parents realize this). If there is a latch problem, then I strongly discourage bottles and prefer to teach cup feeding as baby-led, vs syringe feeding which is "forced". I also tell them that pumping is absolutely necessary in order to "tell" the breasts about the extra that the baby has eaten, but remind them that if they express any milk, it can be fed to the baby as the supplement, in place of the "yucky stuff" (yes, I DO use those words!!!) As an aside, my biggest challenge comes from the nursing staff, who get worried about a baby who does not eat, pee or stool on "my shift", rather than looking at the 24 hour picture. The nurses then convince the mom that the baby needs food ("see, he is crying, he must be hungry" or "your baby has lost weight" or "your baby has hardly had any wets"), make her feel guilty or worried if she doesn't give in, give a bottle and say "see, he was hungry" b/c he was force-fed 1-2oz (30-60cc)and THEN, document "baby bottle-fed at mother's request"...arghh! Kathy in NJ IBCLC RN C (Maternal-infant), APN C (Family Nurse Practitioner) PhD student hoping to study labor and lactation issues *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html