I am a nutritionist working with children with special needs, and recently
have been assigned a case of a 3 month old boy.  He was a 5 wk preemie,
3#6oz. Has no cardiac problems, no medications, and has been gaining weight
steadily. Wt is 7#9 at 9 weeks.   Mom has been giving combination of
formula and brmilk ever since birth and is now down to pumping 1x/d.  Has
given up the idea of ever getting him to breast.    He has 'noisy
breathing' but no dx of any respiratory problems.  Was seen by ped at 2mo
and no appt til 4mo.    Was referred by the Early Intervention team to our
nutrition team and to me as the LC.
     Mom was planning to give up bf since he refused the breast, she works
and has 3 other children, until I told her about the benefits to the baby
in terms of immune protection even from some brmilk.   Then when I
suggested an SNS she practically jumped at the idea.  I will see her in 5
d, she is to pump 6x/d til then, and we will coaxe him to the breast if
possible.
        Meanwhile he can't take any more than 2 oz ABM by bottle without vomiting,
and is not a demanding feeder.  His tongue will come out beyond the gum and
does not look unusually thick. I will be doing more of an assessment when I
see them Monday.
  Resources?   I have lots about Down Syn. but not much about how to work
with them   to  BF.    Personal experience I could share with this mom?
  She bf her 11 yo and her 9 yo, at a time when not much support was
available and without a lot of education about the process.
     So, in addition to my request to the archives, would love your input
  TIA,   michelle  scott, RD,IBCLC