I'd be wary of using a nursing supplementer at breast unless mom's milk 
production is very low. It would likely be better to nurse very, very 
often (every one to two hours during the day, and at least once in the 
night) with the baby's head more extended, and the mother reclining so 
the baby is more prone.

I agree that this baby is not getting sufficient milk or calories. What 
is it with the '10 mins on each breast then give 2 oz abm' advice that 
so many pediatricians seem to give for babies of any age? If mom can 
pump 3-6 oz, her baby may be able to get what he needs if he can 
transfer milk and have access to the breast often enough.

It's likely that the reason the baby does not want any distractions 
during feeding is that he needs to concentrate to coordinate swallowing 
and breathing due to his tracheomalacia. If he's struggling at the 
breast alone, using a supplementer might disorganize him even more and 
cause aspiration or feeding refusal. Many babies who are having 
swallowing problems would rather sleep than eat. Paced bottle feeding of 
pumped milk might work if a supplementer gives too much flow.

Catherine Watson Genna, BS, IBCLC  NYC

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