Regarding Kitty Franz's comment that there isn't any difference between
finger and bottle nipple, I have to say that there are quite a few
differences.  First, when done by parents (who only need to wash hands
thoroughly whereas we should wear gloves) baby feels skin in the mouth, just
like the breast is covered with skin. Second, you can tell more what is
happening in the mouth with your finger than with a bottle.  Often finger
feeding is an extension of a digital suck assessment (which I know is also
controversial, but sometimes it's the only way to figure out what's going
on).  Some babies seem to need the presence of milk, not just the physical
presence of a "nipple" to trigger the suckling.  With breastfeeding, baby is
generally in control of the flow, with bottle, no one really controls the
flow, (although we can vary it somewhat with positioning) and with finger
feeding the one doing the feeding can have some control.  This can be an
advantage both in keeping baby from being overwhelmed since with a bottle
often baby winds up swallowing "out of self defense, ready or not", and in
helping train a baby to suckle effectively.  Baby can be rewarded with a few
drops of milk whenever he makes progress toward effective suckling and milk
not delivered when he "humps the tongue" or whatever behavior is interfering
with effective suckling.  I do feel that for complex cases, someone trained
specifically in suck problems needs to be involved, but I feel any LC should
be able to use simple interventions and if those are not successful, refer.



Any research is going to be complicated by the fact that so many factors
enter into a decision as to whether to use an alternate feeding method and
if so which one.  Among these are: Is the reason baby or breast centered?
Is the immediate need to "get something into the baby" or to make progress
toward effective breastfeeding?  How much intervention can the parents cope
with at this stage?  Which tools does the LC have at hand (including which
ones she is comfortable with)?  Then we frequently wind up with some degree
of "trial and error".  We may have an idea of what will work best, but in
actual practice find that this case requires something different.  It would
be great if lactation were an "exact science" but I doubt if it (or any
aspect of medicine) will ever be completely so.  We always start with "the
evidence indicates that_____is the likely problem" but often have to rethink
when the situation proves different.



So, again, finger feeding, like everything else we do, is a tool-one of many
at our disposal.  It can be the most effective tool in some situations and
the worst in others.  This profession is definitely not one where "one size
fits all"!



Winnie


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