I've only been working with newborns in a hospital for eight years now.
Before that is was two and three weekers and older, not in a hospital.

We only have babies 36 weeks and older at our hospital's birthing  center.  I
read the suck training articles very carefully in the 80s and  90s and tried
some out back then.  The newest Breastfeeding Answer Book has  descriptions of
finger walking on the tongue and also something on a tongue that  pulls back.

I posted a few days ago about the Actifier because I think it could be a
great tool in the future to use with babies such as the one I describe  below.
I'd like to have the inventors of the Actifier come to speak at a  conference -
ILCA - LLLI?  about the mechanisms of suck as they know them.

Here is what I have gleaned from my experiences with new mother baby dyads
over the past 8 years.  We do finger feeding with either a soft medicine
dropper that doesn't hold much more than one or two mls or with a 10 or 20 cc
syringe and feeding tube.  We never tape the tube or dropper.  We  place it along
side the finger not quite as far in as the finger tip.  I  have not seen any
baby have a problem with that placement.  Most babies who  form seals around
the finger and can create suction are able to obtain  the colostrum without our
squeezing the dropper.  I rest my thumb or have  the parent rest his/her thumb
on the plunger of the syringe to give ever so  slight pressure to get it
started.  Occasionally there is a baby who  doesn't create the suction, so then we
very carefully apply pressure to deliver  some colostrum.  We honor the
pauses of the baby.

I have found that many babies who do not tolerate forward and downward
pressure on the tongue with only the finger in the mouth, tolerate it just fine
when they are being fingerfed.

As an example, here is what happened with a family.

Baby born and reportedly did not root at the breast and did not open well  at
all.  When the mouth opened slightly and any attempt was made to  introduce
the nipple/areolar complex into the mouth, the baby exhibited a clench
response. I went in on a day off just to see them.  Mom had  pumped some colostrum
(about 4 cc).  First colostrum alone was finger fed  by the Dad who became an
expert at feeling the softness of the tongue between  the back of his finger
(pad side up to palate) or lack of it when baby pulled  the tongue back.  As the
baby developed a rhythmic suck/swallow, the tongue  came forward.  Then rest
of the colostrum, which was quite sticky, was  washed out of the bottle and
pump flange (lots under the white seal) with a bit  of glucose water so that a
total of about 10 cc were fingerfed.  The  parents repeated this at subsequent
feedings while allowing the baby to rest  between the mother's breasts and be
presented to the breast at intervals. Kept  there as long as not frustrated.

In my book this is an example of allowing a baby's tongue to normalize it's
actions while feeding.  I often tell moms that when the baby is born with a
tongue thrust, the very act of the milk coming in and the chance for the tongue
 to get into a rhythm helps the baby to learn to suckle properly. This does
happen in with many babies, but not with all of them who have a tongue
thrust.  Some of them continue to thrust for weeks.

The next day this baby was able to tolerate the father applying slight
pressure while finger feeding and bring the tongue down and forward so that the
tip of the tongue rested on the lower alveolar ridge.  Throughout the day  the
baby was more and more able to suck with the tongue forward.  When  presented
to the breast the second morning the baby did root and orally search  and
tended to open and could be brought onto the breast, but held the tongue  back and
therefore could not place it under the breast nor settle on and start  to
suckle.

The plan is to continue to fingerfeed the baby colostrum with the downward
and forward pressure on the tongue, offer the breast and keep the baby
skin-to-skin on the chest, and if the baby continues to come to the breast with  the
tongue drawn back use a nipple shield to latch the baby.  By the end of  the
second afternoon this baby was more consistently keeping the tongue forward
while finger feeding.

The parents are very encouraged and hoping that when her milk comes in that
the baby will bring the tongue forward to taste some drops of milk expressed
on  the nipple surface and open and be able to latch with the tongue under the
breast.

By the way, we also use finger feeding if a baby shuts down after a
circumcision and is 'on strike.'  By slipping a finger in the baby's mouth,  he often
will start to suck, and giving a little expressed milk via dropper  starts him
swallowing, and then he becomes fully awake and the finger is  withdrawn and
the baby put to breast.  We do not flood that baby's mouth  with milk.  Just a
tiny few drops.

 This also works with sleepy babies who've gone six hours without  opening
their mouths at the breast.  They will take a finger to suck on  (never forced
on them; if they tighten their lips, we might tap on the lips to  see if they
voluntarily open, but otherwise do not proceed without a willing  baby) drink
some milk with the dropper, 'wake up' and latch.  Everyone is  very relieved
when that happens and I haven't seen it interfere in anyway with  subsequent
feeding.  I call all our patients after discharge so I stay  in touch with them
and get feedback.

By the way I wash hands and glove -- we only have non-latex gloves in our
unit -- and the parents wash hands thoroughly and don't glove.

Mardrey Swenson, IBCLC



             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

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