The challenges with pre-term infants <37 weeks are varied, and each infant
has to be assessed individually with a critical eye toward specific deficits
and capabilities.    If the baby has medical problems (illness, respiratory
issues, birth defects, or especially traumatic births followed by lots of
invasive procedures) the course of feeding -- by any route -- is going to be
more difficult. These babies have stamina problems, swallowing problems,
etc.  They need human milk, but may be unable to get enough by oral feeds --
either breast or bottle or cup or feeding tube device.  A fair amount of
these babies develop sensory defensiveness to protect themselves from all
the invasions into their body space.  They may manifest stress cues during
feeds, which distress their parents and complicate parental ability to stick
to a feeding plan.

If baby is merely small, but fairly healthy, feeding -- especially
breastfeeding -- may simply require patience, kangaroo-style frequency, and
careful attention to postural stability.  (Thanks Cathy Genna for returning
to lactnet and for pointing out this issue in her recent post.)

I emhasize getting milk into the baby, protecting milk supply, and looking
forward to the due date, at which time, more serious efforts can begin to be
made to normalize feeding at breast.  Nipple shields can be useful (use only
the newborn small size) both in terms of helping the baby sense things in
the mouth and locating the nipple, and in helping move the tongue (which
tends to be uncoordinated) in to the right shape (central groove) to
organize the bolus for swallowing.  In my experience, this helps increase
the intakes. I understand that someone who has observed the same effect will
be presenting data at the Rush meeting soon.   I see these babies only once
they have gone home, but if the mother is persistent, we usually get these
babies to breast.  Sometimes the feeding problems persist, and I heard
Marjorie Palmer say at the UNM conf. this past weekend that when they reach
the age of some volition (around 3 months)some prems often shut down and
refuse to feed because they associate feeding with such negativity.  So it
is very impt. to respect the baby and be sensitive to finding the easiest
way to feed when baby is still compromised, and use practice at breast as
oral-motor physical therapy to tone and strengthen.
Barbara


Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html