Babies that age tend to take some convincing to take on any kind of change
in feeding, but they can be taught.  It just takes some patience,
creativity, and time.  People tend to get discouraged if a baby won't go for
something new within a few days' time but, really, if the change is
something that is important, it is worth sticking with it for a while.  It
sounds like this mom really wants to keep her baby at the breast.  You could
have her try cup feeding, for supplementation, but go ahead and be making
some attempt to get him to take the SNS, too.  I would try something like
this: at a feeding when the baby would normally nurse to sleep, wear the
SNS, with a sweatshirt, or something that is easy to tuck under it and cover
it well.  Tape the tube (preferably the smallest tubing) high on the breast,
with enough length so it can be brought to nipple level, and flip it back
under the sweatshirt, leaving the tube closed.  Then, when the baby has
pretty much fallen asleep, but it still sucking, unlatch him, flip the tube
down, and try to get him to latch back on, with the tube.  It would probably
be best to keep the tube closed at this point, so that he isn't startled by
a sudden flow of milk.  If he fusses, move the tube and let him have the
breast back, and try the same thing again later.  Alot of babies will take
something new in this manner, a few times, and then become willing to take
it while they are awake.  Persistance with trying things repeatedly seems to
work alot better than spending a similar amount of time at any one sitting.
It is especially important to avoid having the baby become frustrated, and
not try to push a change.  Assure the mom that babies have made much bigger
changes than just adding a tube to the breast, but it has taken some time
and patience.

Anyway, the idea I proposed is just one thought that I think might work.
Encourage mom to be creative and look for cues from her baby of what might
help him to accept the change.  We see alot of variations in what works with
the 4 month+ adopted babies who learn to breastfeed, but the principle
remains the same.

Darillyn

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