Pacifiers are a different issue for premies who are being tube fed. They are actually helpful in this situation, both in releiving the pain and stress of being intubated, and of teaching the infant to link sucking and a full tummy. If infants are tube fed and not offered a pacifier, nasty oral aversions and real difficulties with later sucking can occur. In my own practice, I have assisted premies to transition to the breast even after discharge. This seems to occur more easily before about 5 lbs than after. Here in NYC, some progressive hospitals discharge infants when medically stable, regardless of weight. I have had infants as small as 3 lb 12 oz and as young as 32-34 weeks g.a. transition to complete breastfeeding after gavage and then bottle feeding in the hospital. I wish this were a perfect world and that NICU staff beleived the research showing that breastfeeding is easier for premies than bottlefeeding, but many kids are more resilient than we give them credit. Please don't anyone misinterpret this and think I am in favor of routine bottle feeding of hospitalized infants... Her supply seems very high. Maybe pumping on lower suction would reduce the pain, and single rather than double pumping would reduce the supply somewhat. She could use ice packs to increase her comfort. In the hospital it is easy - have her grab a latex glove or two and fill them from the ice machine. Keep us posted. Catherine Watson Genna, IBCLC NYC [log in to unmask]