This poor baby has A LOT going on. Are they working with a good feeding therapist? Ideally an SLP or an OT who is also very knowledgeable about breastfeeding should be on this case. Asking if the feeding therapist is familiar with Catherine Watson Genna may be a good litmus test! I personally would recommend getting rid of the NG tube and getting a g-tube or PEG tube placed ASAP. The NG tube can contribute to gagging and can be a negative sensory stimuli each and every time the baby swallows. It may also make her more susceptible to reflux by keeping the upper esophageal sphincter slightly open all the time. I know the g-tube placement can emotionally feel like you’re closing the door on oral feeding, but I have seen it work in just the opposite way many many times. Once you get rid of the negative oral stimulus of the NG tube and take some pressure off the baby and the mom and let them relax a bit and fall in love (sometimes for the first time after a long hard NICU stay) the path to oral feeding becomes much easier. It is a minor surgery to have the tube placed, but it is generally just a very minor office procedure to take it out. It is not permanent by any means! I love Nikki’s recommendations of constant skin to skin and offering the breast at will. If this baby does start to nurse again on top of being fully tube fed (ideally g-tube rather than NG-tube) she is a good candidate for test weighing before and after feeds. This is not a baby you want to overfeed. She will be uncomfortable and she will have increased reflux. Small, frequent feedings with an eye at total daily volume would be ideal (rather than an expected total volume per feed every 3-4 hours).

Encourage this mom that anything is possible, including direct breastfeeding. But for the immediate moment I would have her focus on 1) falling in love with baby and making the baby as comfortable as humanly possible (ie lots of skin to skin, hold baby upright during tube feedings & for at least 30 minutes after tube feedings, trial running feedings over 30 minutes with a pump if they are not doing that already), 2) maintain/protect/build her supply and 3) get rid of the NG tube, get a g-tube or PEG tube placed in the stomach. 

Good luck. I feel for this mama. This is the population that made me get my IBCLC. They really need better breastfeeding support. 

Laura Wasielewski MS, CCC-SLP, IBCLC 
Los Angeles, CA 

Sent from my iPhone
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