Laurie,
 
Thanks for your response. Yes, I've tried two different sized nipple shields with very poor transfer on both babies. In fact it is ZERO transfer. I have tried getting these moms to elicit MER first but they still don't transfer well. Both of these moms started off with low supplies, but they have rebounded and are within normal limits with pumping. That's the only good news, but I'll take it! 
 
It sounds like from all of your suggestions, I'm thinking along the right lines, but haven't come up with any good answer that works. As for finishing at the breast, I truly want to try this, but I'm wondering - have you had good outcomes with this method, or do the babies become more bottle dependent? That's why I'm afraid to implement that. 
 
Brenda Phipps
 
 


Date: Tue, 2 Dec 2008 22:22:46 -0600From: [log in to unmask]: [log in to unmask]: two babies with milk transfer problemsCC: [log in to unmask]
Brenda, I don't have any great words of wisdom. But I will just brainstorm here.
I agree CST or chiro may help these infants. Possibly some suck training, which I'm not sure exactly but perhaps finger feeding, rewarding a nutritive suck pattern with a small bolus, or even paced bottle feeding the same way.
I would be sure both moms are protecting their supplies with a regimen of regular milk expression, they probably are doing that already. (is it mom's milk in the supplementer?).
It seems they do well with the supplement flowing, so has mom tried eliciting a letdown and flow prior to latching baby? How are the moms supplies? It seems they could be low due to babies poor suckling, and that could account for why babies do better on sns. 
Re the mother who is frustrated, and is about to start a new feeding system, I would really want to talk to her and try to find out what would work for her. I am not sure the bottle/breast/bottle system will be much easier. She may want to do bottle, then finish at breast to satiety, as was recently discussed here. What about a nipple shield for either or both of these babies? 
These are tough situations, usually with no easy answers. Good luck.
Laurie Wheeler RN MN IBCLC
Mississippi USA 
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