Finger feeding is different from a bottle teat in 2 ways:  the
finger is non-compressible, and flow is controlled and coordinated to
the baby's suck/pause rhythm on the finger, but many babies are unable
to smoothly coordinate suck/swallow/breathe with bottles.  A finger or a
bottle teat provides proprioceptive input to the mouth on the center of
the tongue, which stimulates central grooving and extension of the
tongue, unless the flow is so great that the baby retracts the tongue to
press the tonguetip against the offending outlet.
     The finger can feel the tongue motions, and be repositioned in the
infant's mouth to attempt to correct tongue movements that are
dysfunctional or compensatory- for example, if the infant "tongue humps"
(elevates the back half of the tongue forcefully), the fingertip can be
angled down in the mouth each time the tongue "bunks" against the
fingertip to increase the baby's awareness of this motion.  Over time,
this helps the baby correct it.  I have photos of a mom's nipples whose
baby "tongue humped" for 3 mos before I saw her - cratered only begins
to describe them.  It took a month of fingerfeeding this way, then
moving baby to breast before this baby sucked perfectly and the supply
rebounded (she was down to 3 bf/day when I saw her).
     In general, I think we need a balance between evidence based
practice and innovation.  Our innovation needs to be based on the
science of lactation, and also on our intuition, which is honed by
practice and knowledge.  If we only do what those before us have proven
safe and effective, there will be no growth in this profession.  Nor
should we ignore data that shows our interventions to be dangerous or
ineffective, no matter how entrenched they are in our culture.  Paula
Meier alone has published several studies about the dangers of bottles.
     As for bottles, I do use them judiciously, with proper
consideration of all the needs and abilities of my clients.
--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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