Ann Slaughter writes: Once an infant is about 1500 grams or about 3-3.5 pounds they commonly = start giving feeding cues, some earlier than others. These feeding cues = are just the beginning. We start with extremely small pacifiers, and = advance to oral stimulation with tube feedings. As the infant grows and = continues to demonstrate an interest in oral feedings, without other = complications, we attempt bottle feedings. A baby may know how to suck = and breath but it is the three fold action of suck-swallow-breath that = give many babies problems. The approach in the NICU where I am a lactation consultant is quite different. Babies are fed by tube long before they show feeding cues--sometimes just a few ml's per day to prime the gut (of course preferably with mother's milk). By the time they are showing their earliest feeding cues--sometimes as early as 30-31 weeks--we assist mom in putting the baby to breast. Baby may latch and suck one or two times. We consider this a successful first bfdg session. At first we try one or two sessions per day when infant is awake and showing feeding cues. Often we use a nipple shield since this facilitates latch with these tiny babies who do not have the muscle strength to elongate and hold the nipple in their mouths. When we see nutritive sucking we teach mothers how to do test wt.s. Believe me this keeps the bottle away. If we can show, for instance, that a baby has taken 15 ml from breast and his normal feeding is 30 we give the rest by gavage (indwelling tube). Our goal is to have many, many breastfeeding sessions before baby ever has to have a bottle. As discharge draws near some babies are fully breastfeeding and some are not. We individualize the plan for each baby. Mothers with ample milk supply (even overabundant) seem to have more success bfdg premies because the babies don't have to work so hard to get the milk. Babies that were very small (23-24 weeks) can have many problems including feeding problems--we often work with OT's to individualize feeding plans for these babies. Our major goals are to maximize milk supply, establish bfdg long before bottles are ever introduced, to use slow flow bottles when we do use them and to minimize those. We have seen that even small premies can totally learn to breastfeed before they ever have a bottle. Many of our babies bf for weeks before they get a bottle. Much credit for this goes to a supportive neonatologist in our step down unit, a staff who supports family centered care and in the situations where it works well a very motivated mother. When our mothers are pressured to give bottles we try to help them evaluate whether it is a wise idea. If baby is nowhere near discharge why push it? If full feeding is the only thing keeping the baby in the hospital and it doesn't appear that the baby is going to be able to totally bf for some time then we help mothers to devise a plan where they will bf, pump, and supplement by bottle until the baby is able to totally bf. Didn't mean for this to be so long! Kathy Boggs, RN, IBCLC Mountain View, CA Kathy Boggs, RN, IBCLC Mountain View, CA *********************************************** 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