The baby who is faltering with border-line dehydration, low blood sugar,
and generalized weakness from starvation is not a capable breastfeeder.
Many cases of "poor suck" are just disorganized, hungry babies who will pick
up just fine once they get turned around with some calories.  Any port in a
storm  (i.e. any alternate feeding method that parents can easily manage) is
prob. ok for these short term jump-start situations.  However,   ANY
alternate feeding method has the potential to "confuse" a baby if the milk
supply is so poor that the baby doesn't get as quick  a milk reward from the
breast as they do from the alternative method.  So Rule #1 (Feed the Baby)
is always coupled with Rule #2:  Protect the milk supply.

There is always a reason for poor breastfeeding if we are smart enough to
figure it out.  In fact, there is always a reason why the baby is feeding
poorly even if we AREN'T smart enough to figure it out. (Which happens to me
quite a bit:)

  It is an attractive temptation to blame "nipple confusion" for all poorly
feeding babies.  Ramsey, (Neonatal Sucking and Maternal Feeding Practices,
Dev Med and Child Neurol, 1996, 38:34-47) makes the case that the mother's
ACCURATE perception that her child is feeding dysfucntionally prompts her
choice to offer supplements.  What we want to do as a profession, is get
these moms access to early intervention to figure out what the problem is
and see if it can be remediated before she panics and abandons bfg
altogether.

As Neifert, Lawrence, and Seacat point out in their nice article (J Peds
1996) calling for a medical definition of nipple confusion, you can't call
it confusion if the baby is a dysfunctional feeder in the first place.
There's all kinds of dysfunction, and a lot of it is just temporary.  What
you hope to do is assist the baby's intake while you sort things out.  If
you never completely take the baby away from the breast during the
intervention period, then you generally don't have such a challenge backing
away from the interventions and ending up with a breastfed baby.  That's why
feeding tube devices, nipple shields, skin-to-skin contact are all part of
Rule #3.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html