The rest of the story.  Before leaving my shift at 7am yesterday, I urged
the on-coming charge nurse to contact LLL or a consulting LC.  I was off for
24 hours.  This AM I asked how things were going.  As soon as I left shift
yesterday the baby was given a bottle of formula since he 'wouldn't latch'.
Mom pumped.  Then the nipple shield was used (got a new one, since I threw
away the first one) and baby 'latched' but was frustrated.  I asked if they
thought the frustration might have been because he expended minimal effort
to get milk from the plastic nipple and had to work harder at the breast!!!
I also asked if they had done their own suck assessment and discovered the
lack of reflex with lip/tongue stimulation.  The answer I received was the
pedi said to supplement after all attempts.  Nurse told me that the baby
needed to learn to suck and he did 'really well' with the bottle.  Finally,
early hours this morning he latched with the shied and only took 3cc of
pumped milk after.  Mom was very happy that the baby seemed satisfied after
suckling with the shield.  On my rounds she asked me how long it would take
to get him off the shield. Arrggh!!!

Immediate steps: Personally placed a call to the local LLL  and gave the
number to mom.  I removed all the nipple shields off the unit and threw away
the re-order form!  Yes I can do this, sadly to admit - I'm the manager of
this unit.  (Sad because I am not able to effect beneficial change in the
way they "have always done it")

Next step:  I will engage an LC to give  inservices on 'Potential for nipple
preference', 'Benefits of cup feeding or finger feeding' and maybe one on
'How to support the BF mom".  That in conjuction with discarding all shields
should give them a clear message.  Yes, I will invite the pedi's.

If I sound a bit frustrated, I am!!!

Marley, RNC

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