In the following post I am refering to the term infant.
In some of my more recent clients I have seen with the slow weight gain, poor
suck, poor latch and either good or falling or fallen supply syndrome this is
how I have been treating it.   Undoubtedly this will work for a while and
then I will have to change something!!   I have the mom pump 5-10 minutes and
then supplement with the pumped milk at the breast with a tube coming from a milk
storage bottle with a hole nailed, or drilled in the lid of the storage
bottle.
I 've seen it work best with a nipple shield as I find it helps the baby to
open wide, get a quick latch, slide the tube on the outside of the shield into
the babys' mouth (the bottle rests easily between the breasts).   Sometimes
this step takes a few tries but once the baby gets a good 'hit' of milk, they
suck strongly and the latch tends to improve right away.!   Sometimes they keep
on sucking after the supplement is gone, sometimes not, but at least the mom
KNOWS her baby has gotten 'X' amount of ebm and something from the breast.   I
consider milk pooling in the bottom of the shield a good sign that milk is
being removed by the baby from the breast.
The factors I like about this tool are,
It is fast and relatively easy. To control flow just raise or lower bottle..
Just like science class and the siphon!
It is CHEAP.. Nipple shield $7 -- $10, storage bottles.. Dump the formula
sent home in the 'free diaper bag' tubes.. Ask for some from PP for 'finger
feeding'.!!
It encourages the supply by pumping and efficient sucking.
There is no tape, necklaces, hard to clean bottles involved.
The factors I don't like about this tool are
Asking the already stressed mom to find time to pump.**
The cleaning and care of pump and parts (time wise)
What I see as the Advantages of this method
**The baby who spends an inordinate amount of time at the breast doing
nonnutritive sucking is suddenly 'rewarded' for a little hard work. (this new found
time can be used for pumping)
The baby no longer burns more calories that she/he takes in... sooo
the weight tends to pack on faster.
The baby who prefers to suck on one side only due to birth trauma, injury, or
whatever, still gets the benefits of milk from both sides until the
'whatever' issue resolves itself (from 3   - 14 days average)
It works. The baby develops a great wide open mouth, good suck, good latch
and the transfer from shield to breast generally goes pretty fast IF we let the
baby let us know when she/he is ready.   I encourage some time every day of
braless, shieldless mom with baby in a supine position.
A couple of times, they have both fallen asleep only to wake up to the baby
having found that nipple all by her smart little self.
This may take some extra time in the initial set-up and some creativeness in
figuring out some pump times.   But in general, I have had some nice results.

One more thing, for the supper sleepy, happily starving baby, the tube may
slide right down along side a well placed finger in the baby's mouth.   No need
for tape, no need for a fully awake (TERM) baby.   Most babies will suck in
their sleep and often times, this is all it takes to awaken them, nicer (IMHO)
than the cold washcloth, jiggle, tweek, tickle approach.   Just the subtle
little chow-time reminder!!
I know this is long.. It is also exciting!!
Annie VerSteeg IBCLC

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