THANK YOU to all who responded with the SNS question. This is a very smart mom who has been able to pretty much design her own routine. At the consultation yesterday, the baby took 1.5 oz from the breast, and 1.8 oz formula before we stopped test weighing him. He did continue to nurse more.(We had messed with him a lot and wanted to let him go to sleep on the breast.) The small tubing is what she is using now and it works much better (slower feeding, less formula taken out). This baby no longer needs 30 oz a day like he did before -- he has gained well and is above what we would expect for his age. I had her pump on a Lactina just to see and she got another 1/2 oz total from two sides. So her milk supply is up more than she thought. I believe what was stalling things was the fatter tubing and the shorter feeds from using it. We also did a lot of messing around with the tubing, opening it up and closing it to make baby work harder. He took one ounce of mom's milk from the first breast. This was inspiring to her!  Mom is using the SNS 6 times a day and then was nursing without it afterwards another 6 times. She called it 12 times a day and I assumed that meant 12 on the SNS. Baby will not actively suck without the SNS flowing but once that makes him go, things improve and the MER is triggered. He had milk in his mouth and mom had drops on her nipple after he came off from being nursed without the SNS right after the main feeding. Baby loves to nurse and is latched on well now. I did suggest what you all told me and we are both grateful for everyone's expertise and help. She needed to hear many opinions before feeling more confident. 

Kathy Eng, BSW, IBCLC
Houston, TX

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