Saw this little fellow and his mom this afternoon.  (Was really sort of
a funny juxtaposition in my home visits today.  Worked with this little
guy who won't go to the breast,  after having spent 1.5 hour with a two
month old who won't take a bottle and has mom worried due to two days in
court scheduled for next month, when she will be away from baby for
probably at least six hours each day.)

Mom has taken him in the bath tub with her twice since last week.  First
time he was very relaxed and fell to sleep as soon as g'ma got him dried
off.  Second time he and mom lay down on bed together, skin to skin near
breast.  Mom reports that he spent a very short time licking at the
breastmilk she expressed.  Has shown no interest in working toward the
breast or in latching.  Mom will continue co-bathing.

Mom much more comfortable with the idea that we will work on this, but
no need to rush it before he is ready.  We have a video for teen moms
re: infant massage which I brought to her last week.  She has been doing
that and reports that this is very enjoyable for both of them.  Her face
really lit up and I saw more responsiveness than I had seen before,
which was encouraging.

Today, for the first time, he was taken off the oxygen for daytime hours
only.  He has had some trouble with bottle feeding effectively. From
their description it sounds as if he is bunching up his tongue and
blowing air out his mouth at times.  Since we talked last week, mom and
g'ma aren't force feeding him. Instead they gently take bottle out of
his mouth and start over.

They haven't been using the pacifier, but have been letting him suck on
their fingers instead.  We had talked about how important it is that he
relax and get over gagging when finger touches soft palate.  Today when
I did suck assessment, he had only a little tongue thrusting, and less
jaw clamping.  Gagged only when finger was on soft palate, but this did
not result in prolonged disruption of his sucking when I withdrew my
finger a very little.  We talked it over and have begun finger feeding
him with the starter SNS.  He had been fed about 45 minutes before my
arrival.  Quite willing took about 15-20 ml of breastmilk in 10 minutes
of finger feeding and then fell asleep.  Mom was comfortable that she
could try this at the next feeding.

Interesting to me was that I could not get him to play any tongue
games.  G'ma reported that she had tried to do this too, but he wouldn't
even stick his little tongue out for her.  We talked about doing some of
that.  I'm going back in the morning after hospital rounds.  I was
thinking about trying the ice cube to mom's finger trick, mentioned
earlier this weekend.  Any other ideas????

Mom had trouble with the electric rental pump over the holidays, and so
used a hand pump that someone gave her.  Today she has bruising on one
areola and reports that her milk production is a little down.  I taught
her to do manual expression, which amazed her.  Also encouraged them to
call the rental source and ask for someone to check the pump.

Thanks for the support and ideas both on the list and privately.  What a
challenge each day brings.

Melinda Hoskins, MS, RN
Northern Nevada