Barbara-

I think all of your posts are right on and display a wonderful open
mindedness as well as in-depth knowledge of feeding physiology. I am
intrigued by your suggestion that babies who are struggleing with a rapid let
down and immature neurological systems may be oxygen starved, because I think
this is what happens with the premies I see who have frequent bradycardias on
bottles with premie nipples with a rapid flow, but less frequent bradys while
on the breast. I also agree whole heartedly that Non-nutritive sucking is
really very important for small and/or immature premies or newborns in
learning to  regulate their suck/swallow with swallow/breath mechanisms. We
are all aware of differences in older infants and babies and children in
their developmental and neuological skills-so why not differences is newborns
in their neurological readiness. The OT literature has gobs and gobs of info
on oral desensitization and the importance of learning through touch and the
tactile system. You present some very stimulating suggestions on the ethics
of equipment use. We all want babies to ultimately exclusively  breastfeed,
and if we have to use artificial nipples, whether as a breast shield or a
pacifier,  as the means to the end, I think we have to be open minded and not
loose the whole picture here of the baby as a whole person, as belonging to
the mother (and father) and not just a disjointed mouth and how to fit it
onto a disjointed breast.

Debbie Rabin, OTR, CLC
Los Angeles, CA