I couldn't agree more with Heather's post.  The data certainly do support
poor bfg outcomes with use of bottles in the first week.  I also agree with
her astute comment that it may be related to underlying feeding dysfunction.
Perhaps the bottle use is coincidental.  "Often the earliest and only signs
that reflect central nervous system deficits in babies are related to
feeding." (Ogg, Oral-Pharyngeal Development and Evaluation, Phys Therapy
1975;55(3)235-241.)

"...infants who later showed some feeding difficulties were already
exhibiting poorer feeding ability shortly after birth...this study supports
the validity of maternal perception about their infant's feeding
ability...suggesting that optimal sucking performance appears by the third
day" (M Ramsay and E Gisel, Neonatal sucking and maternal feeding practices,
Dev Medicine and Child Neurology 1996; 38:34-47.  These authors go on to
some conclusions, including this one that is very apropos our discussion
"....Thus, while the mother blamed lack of time for changing to bottle
feeding, it may well be that her infant's poor sucking ability influenced
her decision."

The child neurodevelopmental lit. talks about mothers beginning to take
compensatory action when they see their baby struggle to feed.  This may
involve instituting many more feeds than average or it may be to quickly
accept the all-to-frequently offered early bottle and wean to a method that
clearly gets milk into the baby.

I say again:  If we are in actuality FEEDING SPECIALISTS, we have to be able
to identify why that mother has assessed her baby as a poor feeder.  We must
be able to provide that mother with some answers as to whether this
perception is accurate.  We have to identify the way in which the baby is
compromised, tell the mother what it will take to fix the problem, and give
her a reasonable time frame.  Then we are supposed to make sure she has
support until the baby is returned to the capacity for normal feeding
(defined for our species as bfg.)

While I am considering the possibility that the bottle association MAY be
coincidental or compensatory rather than causal, am I in favor of casual use
of bottle?  No one in their right mind should think that it is reasonable to
pop a bottle in a newborn's mouth for no good reason. We do not practice any
other kind of medicine without protocols, however the feeding of human
neonates is remarkably driven by belief not evidence.

As Heather also comments, there is no good literature that discusses the
effects of later use of bottles.  There is only a little information about
alternative feeding methods, and yet we've based our whole profession on the
promulgation of feeding methods some of which (like finger feeding) have
never been studied.

A recent overview/epidemiologic study (D. Dowling and W. Thanattherakul:
Nipple Confusion, Alternative Feeding Methods, and Breastfeeding
Supplemention:  State of the Science, Newborn and Infant Nursing Review
2001; 1(4):217223).  One of the stated purposes of the paper was to
"describe th current knowledge concerning the use of alternative feeding
methods and long-term breastfeeding outcomes."  The abstract states:

"Mothers of preterm and term infants frequently experience breastfeeding
problems that make it necessary for them to use supplemental or
complementary feedings.  Although bottle feeding is used most frequently,
alternatives to bottle feeding are frequently recommended to avoid nipple
confusion.  This report reviews the evidence of a relationship between
exposure to artificial nipples and the development of nipple confusion.  It
also examines the effects of alternative feeding methods such as cup
feeding, finger feeding, spoon feeding and gavage feeding on physiological
responses of infants and long term breastfeeding outcomes.  This report
recommends further research before alternatives to bottle feeding are
routinely implemented."  The article concludes with the statement:  "  The
relationship between exposure to artificial nipples and pacifiers and the
development of the aversive feeding behaviors associated with nipple
confusion is neither refuted nor supported in the research literature."

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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