I was moved by Kate's example of a baby needing immediate help.  My office seems to be one of last resort for physicians who do not ordinarily practice at my hospital.  It is not uncommon to see a baby slowly starving who was sent home with an alternative feeding device.  The parents are terrified of using a bottle, yet they are unable to adequately feed their infant.  If they are finger feeding with a 10cc syringe and a feeding tube, they usually underfeed the baby.  In their minds, I think they see a syringe-full of supplement as an ounce.  They are usually exhausted, and unable to maintain pumping because the feeding is so arduous.  All of this for a several-week-old baby who is usually weak and willing to sleep long periods of time by the time they are sent here.  

Others, like Kate's baby are sent immediatly from the pediatrician's office and require a short intervention - feed the baby, protect the milk supply, then mesh the two.  I immediatly thought of a mom last week who had such abraded nipples that I was unable to evaluate the baby at the breast.  

While Kate's baby appeared to be breastfeeding well in the hospital, I agree that it likely was not.  Some infants are very savvy tongue suckers, rhythmically swallowing, and demonstrating an adequate digital suck exam.  Years of experience, and trusting the objective data - no stools, low weight gain, jaundice, etc. have taught me how tricky these youngsters can be.  I see them fooling experienced caregivers quite often.

One last note, I promise - I went back to the abstracts of the articles by Gronlund et al regarding infant gut flora and immune modulation.  I originally thought, also, that the B. fragilis being present in the bf infant's gut was in error - surely, they would inhabit a formula-fed infant's gut, since they can be very unfriendly bugs.  I was incorrect.  The authors find it interesting that the breastfed infants are colonized with both the Bifidobacterium and the B. fragilis.  It seems counter-intuitive, and I am wonder if the immune modulation is a good thing - you know, you can induce an immune response that is not necessarily good.  Of course, like all of you, I trust that if it happens in normal breastfeeding, it must by definition by the right thing. I can't wait for more insight into this.  

Denise Sweeney, RN, IBCLC
Mobile, AL

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html