Supplementing at breast can be helpful, but it might not teach this baby
the right thing. Why is this baby inefficient at breast when there is
enough milk to supply her needs? Is there a motor issue, a tongue tie, a
shallow latch that makes breastfeeding less efficient?
When a baby is hungry and weak, increasing the flow at breast can help
the baby get more milk with less work. I love the Lact-Aid nursing
trainer (available from http://www.lact-aid.com ) (I have no financial
interest in this device, just find it generally easier for moms to use
and clean, and more effective at stimulating more energetic sucking). Of
course, if the baby has a respiratory or cardiac issue (laryngomalacia,
tracheomalacia, patent foramina, etc) increasing flow will destabilize
the baby and should not be done.
Some preterm infants breastfeed beautifully, other preterms do better
initially with a combination of ebm bottles and breast, and transition
rapidly to the breast once they learn to make bf work. They don't seem
to do better with at breast supplementation, since supplementers require
negative pressure to work, and that's what's hardest for preterm infants
according to many articles by Lau and Schandler.
For tongue tied babies, they generally have a shallow latch (along with
abnormal tongue movements), which gives them smaller boluses of milk. If
the frenulum is somewhat elastic, then using a supplementer at breast
might be helpful to help the baby catch up and then grow well. It does
not solve the problem, but it does give more milk with a shallow latch,
and allow baby time to grow. The larger mouth can sometimes accomodate
more breast without the tongue being able to extend and draw the breast
in, so tongue tie is sometimes less of an issue as the baby becomes
larger (6-12 weeks of age). Of course the optimal treatment is to treat
the tongue tie and stop the restriction of tongue function, but this is
not available or acceptable in all settings, and may be contraindicated
in infants with macroglossia or hemophillia.
For babies who are weak and tired, sometimes using a syringe and tube or
periodontal syringe to "push" the baby a little can work better than a
more passive supplementer device. Mom needs to be taught carefully to
respect the baby's respiratory pauses, and to recognize when it's safe
to stimulate baby to suck and deliver a bolus and when baby really needs
to rest. This requires a skilled teacher...
Well, I'm sure this is more than you asked for, but it's part of the
decision paradigm I go through when deciding how to supplement a baby.
Catherine Watson Genna, IBCLC NYC
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