Nikki quotes Kitty Frantz' doubts that there is any difference between
ff and a bottle nipple.

First, I want to wholeheartedly agree with Dee's point that the baby
should be gently cued to invite the feeder (finger or bottle) in to the
mouth.  I like to cross the baby's lips with the finger (or bottle
nipple) because that most closely mimics how I position babies for an
asymmetric latch at the breast (chin on breast, philtrum - that little
ridge between nose and upper lip- to nipple).  I find that babies gape
widest this way.  We do this not only to be polite and sensitive to the
baby's personhood, but also to help teach the baby that he is an active
part of feeding. (thanks to Judy LeVan Fram for this insight).  Babies
cannot have a breast just shoved in their mouths, they need to seek and
grasp it, so I think babies need to be taught to seek and grasp anything
they feed from.

If done properly, fingerfeeding has the potential to provide both input
to the tongue muscle to normalize function AND operant conditioning to
the baby.  The bottle nipple is collapsable in the infants mouth, and
does not provide as firm proprioceptive input as the finger does.  (Yes,
the greater proprioceptive input can "hook" a few babies, but a few cup
feedings thereafter usually restores sensitivity).  The finger is
attached to a responsive human being, and hopefully a skilled one, who
can respond to the infant's attempts at sucking to help them progress.
As only one example, the fingertip can be gently angled down against the
posteriorly humped tongue (an abnormal movement pattern) to help the
infant drop and groove it instead.  Milk can be delivered when the
posterior tongue drops (which is how it happens at the breast) rather
than when it elevates if a skilled feeder controls the flow, or a device
like the Hazelbaker that requires negative pressure in the mouth to
release milk is used.  Babies learn quickly... I have this cool video
clip of a baby trying 3 different sucking strategies in succession while
fingerfeeding to find which one "worked" that I show when I teach on
fingerfeeding or sucking issues.

Parents can be taught these strategies, as well as how to use them
respectfully.  The idea of a "therapeutic contract" that is common in
adult therapy applies to infants too.  If the baby does not respond or
withdraws, there can be no progress, and the feeder desists.  If the
baby is actively engaged with the skilled feeder, both are working
together to help the baby improve his skills.

I participated in the clinical testing of the Hazelbaker fingerfeeder.
Previously to that I mostly used syringes and feeding tubes (and still
do use a mix of tools, depending on the particular goals).  The outcome
measure in the Hazelbaker study was the baby being able to transition to
breastfeeding.  If we were to do a truly controlled study of
fingerfeeding, so many factors would have to be weighed...  For
example:  One of the issues fingerfeeding is helpful for is persistent
tongue tip elevation ("peanut butter tongue" thanks to Winnie and Pat
Gima).  There are two major reasons a baby will elevate the tongue tip:
1. he has respiratory instability, and fixing the tongue tip to the
anterior palate helps to increase muscle tone throughout the neck and
shoulder girdle, helping to keep the airway open. or 2. he is
micrognathic (has a small lower jaw) or has an unusually long tongue and
it does not fit in the lower jaw, so he is used to keeping it on the
palate, and needs to use some force to keep it there so it does not fall
back into the airway and block it.  So, any study of ff for tongue tip
elevation needs to carefully screen infants for respiratory issues,
mandible length, and relative tongue length, and be careful to only
compare infants with similar problems.  In my experience, micrognathic
infants take longer to breastfeed well than infants with mild to
moderate respiratory issues, and infants with very long or large tongues
are often incoordinated in using them.  After screening, the infants
would have to be randomized to ff or another method of feeding.  One
needs to be careful of flow in infants with respiratory issues (and in
infants who have reduced posterior tongue grooving), so it needs to be a
slow method.  See what I mean about the level of complexity here?  It
would need to be done at a very large medical center with a large number
of skilled IBCLCs.  Then there's the issue of whether or not parents
randomized to ff are able to implement it properly.  In clinical
practice, if the lc sees that the parents are not well coordinated, she
is going to choose a different strategy, perhaps bottle feeding for
nutrition with pacifier tug of war games to improve tongue function.
Catherine Watson Genna, IBCLC  NYC   (Not trying to be a wet blanket,
but wanted to inject a little reality check here.)

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