Of concern to me in the original post was the comment that mom had "pushed milk through" with finger feeding and then was "pushing milk" at the breast, for three weeks now if I remember correctly.  In my experience, pushing milk can be a red flag.  It can cause disorganization if not timed perfectly.  Once a baby is getting sufficient calories, the suck should improve.  When a mom has to "push milk," either the baby doesn't want milk as per swallowing issues (previously mentioned) or baby *can't* suck for another reason that needs to be ruled out.  How are the baby's reflexes?  Oral tone?  Stamina?  Jaw gradiation?  If the IBCLC isn't trained to assess these things and mom is "pushing milk" with no improvement for an extended time, a referral is needed.  In my area, I refer to an SLP.  In other places (USA) an OT.  If a mom must push milk for weeks on end with no improvement, bottle-feeding is likely inevitable for most moms.  A baby doesn't have to suck to get milk from most bottles, so bottle feeding could work for a baby that wasn't referred for suck issues.

A have a couple more bottle thoughts to throw out, too.  First, there is no industry standard for flow rate.   Any company can claim any bottle nipple is slow.  My co-author and I have also tested nipples and flow.  There are some brands packaged as medium flow that flow slower than brands packaged as slow.  Among the slow brands we tested (31 brands thus far), one slow nipple flowed 14 times faster than a different brand slow nipple.  We have not tested the Calma nipple and bottle, so I can't give figures.  Upon viewing photos, I wouldn't be surprised if this shape gagged many babies.

Amy Peterson, IBCLC
Idaho

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