Sorry this is a late reply, I'm way behind...
One way to help a sleepy baby suck more effectively is to supplement at
breast with a syringe and 5 french feeding tube.  Whenever baby pauses
longer than needed to breathe, mom delivers a single, small (.5cc) bolus
of expressed milk (can use expressed hindmilk to increase the calories
as well) to induce the baby to swallow, which triggers the next suck.
THERE ARE SOME CAVEATS, though, the  baby must not be pushed so hard
that respiration is compromised, and I would be cautious with this
approach with any baby who has difficulty handling a bolus of milk
(tongue tied babies who gulp loudly, babies who pull away in distress
when milk flow is high).  This requires careful demonstration and return
demonstration, making sure the mom understands how to assess the signs
of stress in her infant such as finger splaying so she can reduce or
terminate the flow of extra milk.  The other thing an LC needs to assess
is whether the baby is pacing the feeding slowly due to cardiac or
respiratory difficulties.  These babies stop sucking when they run out
of oxygen.  If we are shooting extra milk in their mouths by any means
(including bottle), this can bankrupt their resources and lead to
feeding induced apnea or hypoxia.  I would not use this technique at all
unless you feel confident about being able to assess all these issues.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]