I think that conferences are wonderful places for speakers to discuss
research and to open up ideas for consideration and debate.  We are a new
field, and many ideas we started out with have had to be re-examined because
they weren't evidence based and didn't really work in practice. But I am
personally always a bit horrified when some idea I've tossed out at a conf.
suddenly gets parroted back to me as the "new rule."

I wasn't at the WALC conf, but I frequently discuss and describe alternative
feeding practices.  It's important to remember that there is a lack of
research to support some of the methods LCs have advocated -- particularly
with regard to safety and therapeutic efficacy.  We need to address this
issue and to really do some work that more closely examines these issues,
particulary with regard to infant respiratory status.

 I personally do prefer bottles (with pacing technques) when alternatively
feeding non-nursing infants.  They typically are my first choice method
unless thebaby just need a quick jump start -- in which case I  finger-feed
with an inexpensive periodontal syringe.  I like the way bottles help the
tongue shape the central groove, and I like that I can select different
lengths and textures of teat. I usually have some deliberate therapeutic
direction in mind.

  That said,  I don't think the time has come to make blanket pronouncements
such as "forget about every other method and just use bottles."  That is the
same kind of dogmatic approach that so annoys me when applied to any other
aspect of bfg management.  All care should be individualized.  The minute
you start saying "always and never" you create problems.  The correct answer
as to how a non-nursing infant should be alternatively fed is:  "It
depends."

The BIG issue is the safety of the feeding method for the baby. This must be
assessed.  Babies have different kinds of problems that prevent them from
bfg and the type of problem may, in inself, dictate the best method of
supplementation.  A good example might be the use of a chambered bottle for
a baby with a cleft, since a feeding tube device is next to useless for a
kid who can't create suction.  However, why use a bottle when a feeding tube
is a great way to feed an adopted baby?

You also have to consider how long the intervention (i.e. the
supplementation) will last, the cost of the supplies, the ease of their use
for the parents, the skill of the parents in using the feeding technique.
I think it is also fair to say that the helper (you, the LC) may have
preferences in terms of the tools you like and feel comfortable with.
That's fair enough.  If LCs are careful to teach (by return demonstration)
the correct feeding technique to the parents, then the parents may also be
interested in adopting one method over another.  But what you have to think
comprehensively about is,  what alternative feeding method will best assist
a return to normal feeding in this individual?  (Normal infant feeding is
defined for our species as breastfeeding.)

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com
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