In a message dated 4/11/05 12:02:03 AM, Jennifer writes:


> He has been home now for almost 3 mos, and is exclusively breastmilk
> fed
> Mom
continues to have a great supply, and stays ahead of the baby easily
ittle guy struggles with direct
breastfeeding, and never seems satisfied, and she rarely feels a letdown
  His
growth is great - he's almost 11 lbs about being born at 1 lb 11 oz.<<

Hi Jennifer,
In a former life I was an MCH VNA nurse, providing weekly, sometimes biweekly 
visits to these former premies and before that, a NICU nurse.
Very few of the babies that we successfully transitioned to the breast once 
home -did it easily! The longer the bottle feeding (older, wiser baby) the 
harder the transition. MOST of my parents interpreted this as "breastfeeding is 
too hard". They saw their fragile, miniscule premie who had been tube fed for 
weeks and required hyper vigilant monitoring of intake- every time they looked 
at their NOW much healthier, growing infant.
 Often the obstacle was latch. In your instance it seems as if he IS latching 
AND feeding. Mom just questions the adequacy of his intake. Based on his 
growth, age and size,   I would encourage Mom to challenge him more at this point. 
Most likely he isn't feeding "well" from the breast because he hasn't got the 
message that he has to! He is using "the breast as an appetizer", a very 
common phenomenon with ALL babies who are primarily bottle fed (hence the 
development of the term!). I would encourage her to choose a period of time where she 
agrees to ONLY breastfeed, this may be ALL day time hours for one day(if she 
is particularly ambitious!) or even a 4-6 hr span   -where she climbs into bed 
with him -accompanied by food, TV remote, books, magazines etc.... and feeds 
whenever interested.
 IF she elects to try for day's entirety, I most often found by evening baby 
had seemingly "got it"   and was actually feeding at breast. I would instruct 
Mom to continue nursing during night followed by pumped EBM to supplement. 
Continue night time supplements until weight gain is established on this regimen. 
If she elects briefer period, the transition will take longer but it may be 
all she can handle at this point. As long as she continues to challenge him for 
a little longer every day, he should make the connection. Obviously she needs 
lots of reassurance that this will be ok for her baby! She will need to know 
that he will not "starve" or "dehydrate" but also that he can't be expected to 
learn something that he has little impetus nor desire to learn-he receives 
his "meal" from the bottle!
I have used variations of this many times with good success.....some smaller, 
younger babies required weeks of nipple shield use prior to successful 
transition, some Moms used an SNS to supplement but I 'm sure you would have 
considered these options if indicated.
Other LCs might advise using test weights at this point. These COULD be 
useful once the baby is actively transitioning ie. we know baby is feeding at 
breast and we simply want to offer Mom an added measure of reassurance. I would 
avoid using them in the immediate sense however because we can assume that until 
he "gets it" he won't be "getting enough" -to grow and this FACT will make her 
nervous!
As for letdown, IME, most Moms can't identify a letdown sensation at all.

Lynn Shea Rn,Bsn,Ibclc
Lakewood Ranch, Fl

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