A thoughtful recent post discussed some of the factors needed to remedy
nipple confusion.  The poster listed "skillful LC help" and a persistent mom
as two important requirements.  I agree with this, of course, however, the
first issue to consider in situations where baby is refusing the breast is:
What is wrong with the baby?

My practice primarily involves working with breastfeeding problems, some
quite severe.  This has been my focus for the past 13 years of priv.
practice, and it was my focus in the PL Dept. for LLL for the 5 years prior
to that.  Many years I've seen 350-450 women with various problems.  This
experience has given me a lot of perspective on dysfunctional feeding vs
normal feeding ability. I reply from this perspective.

 People are probably getting tired of me saying this, but the baby who can't
breastfeed has something wrong with him or her.  Hopefully, it is a
temporary problem, but sometimes inability to bfeed is the first sign of an
enduring problem.  Perhaps the baby is preterm, ill, drug affected, or
injured from the birth.  These are prob.  short term issues.  Or  the
problem could be connected with a physical deficit that is hard to spot
(like a submucosal cleft of the palate).  It could be a neuro-muscular issue
(like poor tone or incoordination).  Or it could be a neuro-sensory issue
(see Cathy Genna's wonderful article in the last Leaven on sensory
integration disorders).

If such a dysfuctionally feeding baby gets a bottle (or whatever) to get
calories into them and following that, it's STILL hard to get them to
breastfeed, it's not because of the bottle.  For instance, the post from the
gal in Australia.  She describes a 6 wk old baby with bubble palate and all
sorts of related issues and wants to know can baby go to breast.  Sure, keep
trying, but the baby's feeding failure pre-dates the bottle. This baby has a
bunch of stuff going on. Try to figure out what's wrong with the baby, fix
or modify that if you can, and if/when baby can manage, baby will
breastfeed.  Babies are born wanting to breastfeed. So long as you have a
good milk supply, there's always hope.  Of course the older the baby (esp.
past 3 months) then you can have real refusal.  Prior to that, I'd stake my
reputation on inability as the reason for breast rejection.

The skill of the LC, while important (esp. in terms of trying to figure out
what baby's problem is) pales before the issue of the skill of the BABY.

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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