Kris -

Some of the babies that I have seen have become "used to" the bottle after
the breast and seem to self limit at the breast.

I explain to mom that it would be like if I told her "after every meal, you
need to eat two peanut butter sandwiches.  You can eat whatever you want at
your meal but you MUST eat the two peanut butter sandwiches."  Since the
baby does not have much control over how much milk from the bottle, he needs
to learn to limit his feedings at the breast since that is where he does
have control.

Since the baby is not getting enough milk by direct feeding but the milk is
there (as evidenced by pumping) either he cannot get it or chooses not to
get it.  If he cannot get it, that must be evaluated and dealt with.  If he
chooses not to get it, a more easily controlled method of supplementation
might be tried.  Options might include SHORT TERM cup or finger feeding.

Alternatively, using the SNS with more instruction might work.  If she is
using the starter SNS, I would definitely consider changing to the full size
SNS.  She might even consider using the larger tubing for faster flow.  With
either SNS, I have found that using it per the instructions of putting it
under the top lip nearly impossible for most moms.  Instead, I have had
excellent success with putting the tubing on from the direction of the
center of the lower lip.  The tubing is placed so that it reaches to the
center of the tip of the nipple and an extreme off-center latch is used.
Mom feeds from the first breast, using compression as needed until
swallowing slows then switches to the second breast with the tubing
attached.  She repeats with using the latch and compression until swallowing
slows and then opens the tube.  Obviously pumped milk is used first in the
tubing then formula if needed.  I usually tell moms who do not produce
enough milk to make sure there is milk left in the device at the end of the
feeding so that baby quits when full rather than when the food runs out.

The entire idea of this is so that baby learns that breast = food and he
does not need to worry about the bottle coming after the breast.

Good Luck, I would like to know what works for this one.  I see several of
these per month and am always looking for new tricks.

Linda Pohl, RLC, IBCLC
Phoenix AZ
www.eBESTFed.com

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