Hi Jaye,
The partial abruption is a really good contender for the cause of the 
baby's neurological issues.

Don't underestimate the power of your support in this case. I know 
Barbara Latterner already said that, but I think it is important enough 
to say again.

The g tube is probably a great idea for this baby. Takes all the 
pressure off of feeding. Baby can get what he can from breastfeeding, 
and have the rest through the tube. It might be helpful to let him 
breastfeed or suck a pacifier or finger during the g tube feeding, if 
mom can manage (some methods of g tube feeding take one hand, some take 
2, depending on whether mom uses gravity flow or a plunger in the 
syringe.) If baby consistently takes a certain amount from the breast, 
he can be given the remainder first, and then be breastfed, so he 
continues to associate feeling full and happy with  breastfeeding, or at 
least with sucking. Usually though babies with neurological issues are 
inconsistent feeders, doing better when they are more organized and have 
more energy (perhaps right after a nap) and more poorly when they are 
stressed or tired. Neurotypical babies also feed better when more 
organized, but with infants with neurological impairments, the 
differences can be more marked. Mom should probably purchase a scale 
(the Tanita BLB-12 is the most affordable of the scales that accurately 
measure breastmilk intake). Renting is another option if her medical 
insurance will pay for it that way. One of the moms in my practice with 
a neurologically impaired baby purchased a scale, and she is going to 
sell it to one of my interns when she's done with it.

The other thing you can do for this dyad is to help normalize feeding as 
much as possible. Breastfeeding is normal feeding, so if you can be 
there when the early intervention team meets to remind them of that and 
ask for breastfeeding related goals to be worked on first, that can help 
too. You can share your breastfeeding expertise. Sometimes speech or 
occupational therapists want to work on "lip closure" with a bottle. You 
can explain that for breastfed babies, normal lip closure is larger and 
see if they can work on it on the breast (can be done) instead.

There's tons more, but my tired brain is not working to get it all out. 
Spent today returning my baby to college after her first week off 
(sniff, sniffle!).
Catherine Watson Genna, IBCLC  NYC

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