Christine from Wisconsin writes about her NICU doc's remark that there isn't
any good science to support alternative feeding methodology.  He's not far
off the mark.  What we do have, in general, merely documents that it is
possible to feed babies in alternative ways.  Some of the studies even
catalog a few details like how various feeding methods influence
respiration, or identify a few specific risk factors for the method.  But
that's about it.  We know that babies can drink out of many devices, and
will gain weight.  We know that some devices have more problems with
spillage (cups) and intake must be carefully monitored in those babies.  We
have some information about varying flow rates with bottle teats made of
different materials and as the result of different numbers of holes in the
teats.  I was unable to find any studies published anywhere on the practice
of fingerfeeding. That is not to say I never fingerfeed, but only to say
that there is no research to support any claims on behalf of the technique,
and the risks have not been cataloged.

 Much of the information about paced feeding is in the Occupational Therapy
(OT)  literature, which is where I learned how to perform paced bottle
feeding.  In my own practice, I've adopted and adapted pacing techniques
when I perform and teach (by return demonstration) things like finger and
cup feeding.   I often find that suggestions to parents that they feed with
something other than a bottle are provided with scant attention to the
importance of observing the baby's respiratory rate while feeding. I think
this is neglectful and risky.

I agree with several other posters that there are probably more similarities
with the bottle and breast than with the other types of feeding implements.
With one exception:  The baby's mouth is not as wide on the bottle.  And
this is exactly why bottles work better for babies with weak facial tone.
It is quite difficult to sustain a seal on a large round object.  Weak tone
in the cheeks, jaws, lips etc. causes babies to compensate by switching to a
clamp to hold the nipple in their mouth.  It is painful to the mom and
results in inefficient suck when they narrow their gape and shorten up,
slipping out to the shaft of the nipple to suck (because they can no longer
sustain a seal with a wide gape on the breast itself.)   It is easier for
the baby to sustain a competent seal around the base of most bottle teats.
This is where good assessment comes in.  If the facial tone is an issue,
graduated sizes of bottle teats (from narrow base to wider bases) can help
the baby practice sealing around increasingly larger diameter objects.  Then
a shield can be used to help transition the baby to breast.  So
understanding more about how tools work and why a baby would require an
assist is always useful in case management.

Susan Burger wisely calls for consolidation of our understanding of the
issue of alternative feeding.  It's not really a "science" yet, because too
many of our assumptions are un-researched and are based on prejudice.  I
have no interest in promoting bottle feeding per se (because like all
methods, it has risks), but I have a great deal of interest in understanding
as much as I can about how to return non-nursing infants to full, normal
feeding (defined for our species as exclusive breastfeeding).


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