Kirsten, this definitely sounds like an oral motor problem. Most older 
babies can down 3 ounces in a bottle in like 5-10 minutes! The Avent 
bottle can be chomped more easily than other bottles so this may be why 
it is working for this baby. I have worked with some babies that can't 
breast or bottle feed well. A video flourescent (sic) suck swallow study 
could be helpful to see what is going on in the mouth and with 
swallowing. I would try a Haberman Feeder if your WIC can get one. It 
may take the baby 3-4 times with the Haberman to learn how to use it but 
it often helps the baby who can not do bottles well. I find they can 
manage the Haberman in less time and start acting less stressed once 
feedings improve. Some of these babies are later moved to a faster 
flowing nipple by the SLP or OT and mom reports that helps. You have not 
let this mother down -- if the baby can't do it, she can't do it and an 
LC is not usually qualified in this area. You can help this mother by 
encouraging her to pump 8 times a day to keep up her supply and trying 
to find a good SLP or OT to refer her to. A call every week to tell her 
how wonderful she is and what a good mother she is will cheer her up. I 
also find that my HCP report to the pedi describing the problems (not 
diagnosing) and then recommending an evaluation by an SLP or OT is often 
very helpful. I like to watch the mom breast and bottle feed so I can 
describe what baby is doing or not doing to the doctor.

Kathy Eng, BSW, IBCLC
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