It all depends on how fingerfeeding is performed, Kelly. It's rare that 
babies get hooked on fingerfeeding (or bottles in my practice). And if 
they do, we just use a cup for a day or two, and that usually takes care 
of it. I do like cups for use in the first few days, but for long term 
use parents often have a hard time getting sufficient milk into the 
baby, and we don't want to spill precious human milk when mom has a low 
supply.

I help preserve the gape response when using any "preformed" feeding 
implement, including bottles and fingers, by crossing the finger (or 
bottle nipple) across the baby's lips until they open wide and have 
their tongue down. Then the finger or nipple is allowed to touch the 
front of the baby's tongue, to encourage the baby to pull it in, at the 
same time the nipple tip or finger tip is allowed to slip under the 
upper lip. If the baby starts closing down before clearing the finger 
tip or bottle nipple, it is removed and we start over.

One can fail to deliver milk until the baby sucks several times, to 
encourage them to wait for the MER. I often do this as well.

I want to clarify my recommendation for the particular baby that started 
this thread: A one hour feeding that does *not* result in adequate 
weight gain is too much, in my humble opinion. The baby gets exhausted, 
and mom's milk production is not stimulated well. What I was 
recommending in this case was that the baby be breastfed BRIEFLY (as 
long as he was sucking and swallowing effectively (less than a 3:1 
suck:swallow ratio), and then the feeding finished another and more 
efficient way, so mom would have time to pump. Her supply was 
increasing, as was baby's intake, but not rapidly enough to assure a 
good outcome. Giving baby extra food for a little less work (a tube at 
breast could also work well) can help increase his strength and sucking 
ability quickly. And since he's getting milk from the breast, he'd be 
less likely to refuse the breast in favor of the alternate feeding method.

Remember that milk production is calibrated early on, and  the longer we 
let a baby and mom "eek along" the more likely the milk production is to 
be calibrated low. I certainly believe in giving "just breastfeeding" a 
try (with optimal latch and breast compressions), but this baby had gone 
several weeks without the robust weight gain that thriving breastfed 
infants show in the early weeks. Again, it's just my opinion, but it's 
informed by years of working with difficult situations.

Catherine Watson Genna, IBCLC  NYC

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