Hello, Melanie.
You ask if anyone has suggestions for helping this premie do better at
breast. You report that baby pushes mom's finger out of his mouth when mom
tries to let baby suck on her finger. You also report that baby mainly flutter
sucks at breast.
As someone else suggested (I can't remember whom and can't find it
back), a baby who is under 6 pounds and not yet reached due date is still
immature and can have trouble breastfeeding just because of that. However, many
times, these "little bitties" have the correct technique, but not the stamina
needed to complete their feedings at breast, so need supplementing. But in the
situation you are working with, it sounds as though the baby doesn't have the
correct technique at breast, either.
I have often seen babies (premie and full term), who have been
supplemented by bottle, push mom's finger and/or nipple to the front of the mouth.
Often this problem arises because only the shaft of the bottle nipple is being
placed in the baby's mouth. Not only does this cause baby to hold his mouth
tighter to maintain a seal around the narrow shaft, but it teaches baby that
something should only be in the front of his mouth. This often happens when
people use a bottle with a wide base, such as an Avent or a disposable system,
where the baby can't possibly get his mouth around the base, so has to content
himself with just the short shaft of the nipple. But I have also seen it
happen with smaller-based nipples when parents don't insert the nipple all the way
into baby's mouth.
Frequently, babies seem to temporarily lose the ability to tolerate
touch on the back of the hard palate if they have been fed with only the short
shaft of the bottle nipple in their mouths for several days or longer. So when
I switch babies to my method of bottle-feeding, sometimes we have to start
with the baby taking only the shaft, and then slowly, very slowly, twist and
push the nipple in farther, bit by bit, to gradually desensitize baby's
discomfort on the back of the hard palate.
I have also frequently seen babies who have been fed with the
regular-flow nipples (usually a fast-flow) that hospitals provide get used to having
the food fall into their mouths from the fast-flow nipple. (This is especially
true with those incredibly fast-flow "red" premie nipples we have in the
USA.) So then the babies just kind of "hang out" and do nothing but fluttersuck
at breast, while waiting for someone to finally decide they can have that
bottle again! That's where using a slow-flow nipple when offering supplement by
bottle can help these babies learn to put some effort into feeding, as they need
to do at breast. Sometimes (usually when babies weigh less than 5 pounds), I
find that the slow-flow nipple is just too taxing and the supplemental
feeding takes too long and baby wears out before he takes in enough. In those
cases, I will suggest using a medium-flow nipple until full feedings take less than
10 minutes (or supplement-only feedings, where we can tell baby is getting a
fair amount at breast, take less than 5 minutes), and then switch back to the
slow-flow nipple.
You didn't specify how the baby is being bottle-fed, but perhaps these
suggestions will help to transition baby to breast.
Dee
Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA
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