I vividly remember the wizened old man of a baby who was brought to me many years ago, when he was probably a few weeks old.  We started with an SNS, and a few days later the family came back, mom looking perky, dad looking utterly defeated, baby looking as bad as ever.  

"He's doing fine; he's just not hungry.  See?" she commented, as the baby took a few sips and stopped.  Not hungry?  He was clearly starving.  I broke out a bottle and the baby slugged down 3 oz.  We abandoned tubing-at-breast until we all had a feel for how much the baby *wanted* to be taking at each feed, and what his behavior and diapers were when he was well-fed.  Mom left my house sagging, but dad looked reborn.  She was one of the few mothers I've seen who really denied how poorly her baby was eating until she had clear evidence to the contrary.  Dad knew, and felt the weight of the world lift when someone else agreed that "we have to feed this baby."

What I felt I learned was that a baby in peril *may or may not* do well with a feeding tube, and it can be hard to tell - at least for me.  Yes, we could weigh baby and supplementer and try to figure out if what he got from mom plus what was in the supplementer equalled a full meal.  But with those babies who need to eat NOW, it's simpler and faster - for me, at least - to focus on Feeding The Baby and, as someone here said, "sort out the utensils later."  Once the baby (and the rest of the family) has more energy, *then* we talk about breast-oriented ways to supplement.

(The wizened old man was ultimately very successfully and happily tube-fed at breast.  His dad tuned our piano in thanks... and it hasn't been tuned since.  Ouch!)  

Thank you, Linda Smith, for those 5 rules.  If they didn't originate with you, I certainly learned them from you, and it has made my job oh so much easier!

 Diane Wiessinger, MS, IBCLC  Ithaca, NY  USA
www.wiessinger.baka.com

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