I continue to be concerned about counseling for problem breastfeeding
situations which occurs solely over the internet and takes place in the
absence of any direct observation of the infant.  Prematures do have stamina
problems.  "Crying, and crying and crying" is the most extreme motoric
stress cue a baby can manifest.  This baby should be seen by someone.  I
know that everyone has good intentions in these situations, but there is no
replacement for visualization of a feeding, test weighing (esp. vital with
some prematures in my opinion.) If I was corresponding with a mother who had
a 10 year old who wasn't eating well and was crying and crying would I
attempt to give advice over the net?  How about counseling  the family of an
80 year old stroke victim who stops eating and is crying?

There is a long list of what could be wrong.  Breaking suction could indeed
be because baby is "sucking air"  but not in the way you think.  Often
prematures have problems pacing and coordinating the
sucking/breathing/swallowing rhythms necessary for competent feeding.  They
hold their breath while trying to swallow so they don't aspirate, and then
need to spit out the nipple and pant-breathe to catch up on their
respirations.  This is very fatiguing, but what can the baby do?  You run
out of air long before you starve, so the baby must prioritize respirations.
Naturally feedings are short. Baby could be very hungry.  An even worse sign
would be not being able to muster the energy to cry. If the tandem nursing
has produced a huge milk supply with forceful letdown, there could still be
too strong a spray for preemie with respiratory issues to cope with.  A
weight check would give you a differential dx on that. Please send these
people to a doctor first and then to an IBCLC in their area.  Your
encouragement to do the right thing will mean a lot since you have
established rapport.  The net is great for moral support and sharing
information.  It just can't replace the hands-on that really complicated
situations need.

Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html