Judy, as others have mentioned, the obvious first thing to do is identify and solve the problem that caused bottle supplementation in the first place, then start to deal with the flow preference/nipple confusion.  Hopefully mom has been pumping her milk supply is still available and plentiful.  
   
  I know you stated that you already know about skin to skin, but perhaps you/this mom isn't using it the best way.  From recent personal experience, the very best way to get infant organized to suckle appropriately from the breast is skin to skin.  If its not possible to skin to skin 24 hours a day, then maximizing skin to skin at night/during infants longest sleep phases is best.  I think this works in 3 ways.  First skin to skin stimulates an instinctive(proper) suckling, second, if breast is available at early waking the infant comes into a latching environment in a calm, non threatened state and lastly at night its quiet and dark and there aren't other stimuli to distact/stress an infant who may be stressed a bit trying to organize suckling.
   
  If mom is willing she can do as much skin to skin at night as she can manage.  She can sleep in a semi-reclined position propped up on pillows with infant sleeping skin-to-skin on top of her.  As baby reaches a light sleep stage he will more than likely root around and latch in his sleep before truly waking.  More than likely we will suckle and stimulate a let down(if her supply is good) which will then stimulate more suckling.  The skin-to-skin overnight/latching during sleep is an old LLL approach for a nonlatching baby/breast refusal situation(I am not trying to take credit for this approach). 
   
  I have used it for my oral motor dysfunction son and am SO VERY glad that I started this months ago as my son currently still latches and suckles due to this ongoing nighttime suckling practice.  He latches on without stress during naptimes during the day as well.  It has made all the difference for me in what has been a difficult time.    

  In my humble opinion, there really isn't much else our profession has to offer to get baby back to exclusive breastfeeding.  In the very early newborn period stopping all bottles, syringe feeding with tongue exercises can work quickly to get infant back to breast, but I do not know if this is practical with a one month old.  
   
  I have been very disappointed in the lack of feeding devices that develop/strengthen normal suckling.  The SNS is NOT appropriate for an infant with severe oral motor dysfunction who is unable to latch/maintain seal/suckle effectively.  To my knowledge, there are no alternate feeding devices that promote/train the infant to suckle effectively.  LC's can't even seem to agree on which type of bottle/nipple system to recommend as most compatible with breastfeeding.  But, compatible with breastfeeding is certainly not good enough.  Compromised babies need a feeding device that promotes normal oral motor behaviors.  In this modern era it is a complete travesty that technology hasn't developed such a feeding device.  It is certainly possible.  I have concluded that no one makes money on it therefore it doesn't exist.  
   
  I do hope this mother can make the time to skin-to-skin.  Its the "best" we have to offer, in my humble opinion.
   
  Mary Herrington 
   

       
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