Dear Nikki and everyone else,
Catherine is right on target.  Babies do want to breathe before they  want to 
eat.  If this baby is coming off, a little blow by might help, or  that just 
might be the way it is until he feels better.  He is just trying  to pace 
himself.  If her milk is in, she should pump some off  so  he'll be able to handle 
the flow more easily.  The reason that he has no  problem with a pacifier and 
has to pace himself with the breast is due to milk  flow.  Ten pound babies 
who have RDS make me think of babies of diabetic  mothers, who tend to act 2-4 
weeks less mature than their gestational age.   Could this be a factor?  He 
may be more immature than we think, and along  with the lung disease, he has 
good reason to have to pace himself with  feedings.  
Thank God he didn't have a free-flowing bottle.  Making him eat  by screwing 
in a bottle would be very, very bad!
In our NICU, we'd let this baby breastfeed ad lib with an IV in, unless we  
really thought he was preterm.  We probably wouldn't go for the gavage tube  
for a neurologically normal term baby.  If he were in that much distress  that 
he didn't want to eat, putting in a gavage tube and force-feeding him would  
only stress him further.  His respiratory distress, if it's from pneumonia,  
should resolve in a few days.  And this baby would have lots of opportunity  to 
learn to breastfeed.  
I think Paula Meier's work could apply here.  Her work shows  
cardiorespiratory stability with premies who breastfeed, and not  bottlefeed.  It has to do 
with flow and pacing breathing with suck and  swallow.  There was also a study 
done with cardiac babies at Children's  Hospital in Boston--one of the authors 
was Kim Barbas.  I believe that they  found that these babies tolerated 
breastfeeding very well.  I think both of  these studies show that babies who are 
"compromised" tolerate breastfeeding with  better cardiopulmonary stability.  I 
think you could easily add in babies  with pneumonia.  If sick babies are too 
sick to breastfeed, they don't even  bother trying.  
I have been present while many sick babies have gone to breast.  If  they are 
starting to desat, they pull off and breathe fast to compensate.   If they 
don't feel up to going back to breast, they don't.  
Maureen Allen RN, BSN, IBCLC
Lactation Consultant, NICU
Brigham and Women's Hospital
Boston, MA
 

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