Peg wrote about a situation of SNS and bottle use by two separate moms,

"First, the tape keeps falling apart when she tapes it under the nipple, as
it will get wet from milk dripping.  " 

Find out how she is taping it and from your description she's taping it under 
the breast?  Is this where the baby's tongue is?  So she's using a modified 
clutch hold with baby coming onto breast at 6 and 12 o'clock?  I always 
instruct moms to use a long piece of tape and place the tube in the middle of the 
tape, running along both sides of the tubing.  Because of this method of taping, 
instead of putting tape across the tube to form a +, one inch tape works 
better than the 1/2 inch tape that comes with the SNS.  She also might try placing 
the tubing on the top of the breast, or to the side, though it's more 
physiologic to have the milk coming out on the baby's tongue, rather than the palate, 
sometimes placing the tubing as illustrated in the SNS booklet and pictures 
works better for some moms and babies.  If baby is clamping it may be too fast a 
flow and if using as a straw, then placing the tubing a bit further back on 
the nipple can help so the tip of the tubing is not flush with the tip of the 
nipple.

"Second,  Any suggestions for getting a baby who has gotten used to a fast
flowing Avent back to the breast? "

For this mom, she could use breast compression before those 3-5 min are up so 
baby gets more milk, walk with baby while on breast to distract baby, and/or 
manually elicit MER before baby goes to breast to hasten milk flow while baby 
on the breast.  Will baby go back to breast after the 3-5 min?  If so, 
repeating above might help.  If baby still needs milk and won't go back to breast, 
using paced feeding with Avent or changing to slower nipple, like the Playtex 
Natural Latch, which also has shorter teat and narrower base for better latch 
might help to get baby working a bit harder for her meal and learning flow is 
not constant with bottle just like the breast.  I ask moms how long it takes 
baby to bottle feed and it's usually a surprisingly short time, like 5-10 min for 
2-3 oz.  Then when explaining paced feeding with baby upright and bottle 
horizontal, rather than almost vertical, and milk not quite to end of nipple, I 
tell them that that a bottle feeding should last about 20 min or more depending 
on infant's age.  To help parents gain perspective, I tell them fast feeding 
is like them eating Thanksgiving dinner in 5 min, and it's not their fault, but 
babies with fast flow feeding are drinking because they have to, not because 
they want to.

Hope these suggestions are what you are looking for, Peg, and help.

Barbara Latterner, BSN, RN, IBCLC

 





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