It all depends on how fingerfeeding is performed, Kelly. It's rare that
babies get hooked on fingerfeeding (or bottles in my practice). And if
they do, we just use a cup for a day or two, and that usually takes care
of it. I do like cups for use in the first few days, but for long term
use parents often have a hard time getting sufficient milk into the
baby, and we don't want to spill precious human milk when mom has a low
supply.
I help preserve the gape response when using any "preformed" feeding
implement, including bottles and fingers, by crossing the finger (or
bottle nipple) across the baby's lips until they open wide and have
their tongue down. Then the finger or nipple is allowed to touch the
front of the baby's tongue, to encourage the baby to pull it in, at the
same time the nipple tip or finger tip is allowed to slip under the
upper lip. If the baby starts closing down before clearing the finger
tip or bottle nipple, it is removed and we start over.
One can fail to deliver milk until the baby sucks several times, to
encourage them to wait for the MER. I often do this as well.
I want to clarify my recommendation for the particular baby that started
this thread: A one hour feeding that does *not* result in adequate
weight gain is too much, in my humble opinion. The baby gets exhausted,
and mom's milk production is not stimulated well. What I was
recommending in this case was that the baby be breastfed BRIEFLY (as
long as he was sucking and swallowing effectively (less than a 3:1
suck:swallow ratio), and then the feeding finished another and more
efficient way, so mom would have time to pump. Her supply was
increasing, as was baby's intake, but not rapidly enough to assure a
good outcome. Giving baby extra food for a little less work (a tube at
breast could also work well) can help increase his strength and sucking
ability quickly. And since he's getting milk from the breast, he'd be
less likely to refuse the breast in favor of the alternate feeding method.
Remember that milk production is calibrated early on, and the longer we
let a baby and mom "eek along" the more likely the milk production is to
be calibrated low. I certainly believe in giving "just breastfeeding" a
try (with optimal latch and breast compressions), but this baby had gone
several weeks without the robust weight gain that thriving breastfed
infants show in the early weeks. Again, it's just my opinion, but it's
informed by years of working with difficult situations.
Catherine Watson Genna, IBCLC NYC
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