I would like to pick up the suck thread from Joanne.  I agree totally
that what looks fine is not necessarily so.  Sometimes there are subtle
clues that an infant who looks well attached is not sucking well, but
they require knowlege and experience to pick up.  Some of these are
bizzare tongue movements visible as rippling of the cheek, small dimples,
or a deep nasolabial crease.  I find digital oral exams invaluable in
picking up subtle deficiencies in tongue motion or alterations in oral
anatomy.
        I agree with Joanne that the SNS is not a suck rehab tool.  The
purpose of supplementers when designed was to provide convenient fluid
flow at the breast to induce a baby to suckle and eventually bring
in/increase the mother's milk.  The farther you get from that intention,
the less likely these devices are to be helpful.  Unsustained suck
usually responds to increased fluid flow, but in my opinion it is more
effective if this comes in the form of boluses when the baby stalls (e.g.
syringe) rather than a steady increase in flow like that delivered by the
SNS unless it is squeezed.  I personally like the precision of using a
syringe and tube in this situation.  Finally, I have also found the SNS
to perpetuate dysfunctional suck by rewarding it with milk.  As human
beings, we learn from the consequences of our actions.  If a lousy suck
produces milk, there is little motivation to change it.  The take home
message here it to choose tools wisely according to the situation, and
not get hung up in a knee-jerk reaction to recommend any one device.
--
Catherine Watson Genna, IBCLC  NYC  [log in to unmask]