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Subject:
From:
"Jessica L. Callahan" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 22 Mar 2014 13:41:34 -0400
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This is common behavior for what I see in 'early babies'. Part of the issue may actually be a result from the bottle usage. A couple of reasons:
1) Most bottles flow easy resulting in a little to no effort for transferring milk. Some bottles will leak as soon as they are turned upside down which means that baby will get milk in their mouth before they even have to attempt to suckle. The baby is rewarded with milk in the mouth with little work down on their part.  
2) The bottle nipple is firm and as soon as it goes into babies mouth it hits the babies palate. For some babies this cause them to wait until they feel pressure on their palate before they will even attempt to suckle. 
3) The position the baby is in when bottle feeding is different then when breastfeeding.

If the baby shakes her head upon going to the breast, doesn't close her mouth when the nipple is in her mouth, or even closes her mouth but wont suckle these behaviors I have found are related to the 'pressure on the palate'. These babies tend to do better with the nipple shield because they can feel the pressure in their mouth and therefor should then suckle. 

If the baby suckles a couple of times and then comes off the breast this baby is either pushing the nipple out of her mouth with her tongue or simple just doesn't have the skills yet to maintain the nipple in her mouth and create negative pressure and then suckle. This is normal as well for the early baby (that is a lot to be able to do). This baby may also benefit from the nipple shield. 

From the bottle use the baby may be waiting for a 'reward' prior to doing work like she has been getting from the bottle. This baby may benefit from an SNS used just for the starting of a feed. I find a 5french feeding tube and a 10ml syringe work great for these babies because they just need a little bit to get started. As soon as the baby latches and suckles she will get milk in her mouth with the first suck as compared to waiting for moms let down to happen. But if the baby is unable to hold the shape of the nipple in her mouth then she would benefit from the nipple shield but to prompt her to suckle fill the nipple shield up with milk. Once mother puts the shield on put the tip of the feeding tube into one of the holes on the nipple shield and push milk into it until it is full. Some babies also do well with suckling on a clean finger for a couple of minutes before the breast is offered. 

Does the baby cry as soon as mom puts her in a position to breastfeed but stops crying as soon as she is brought away from the breast? This baby is not associating feedings with the breast. She knows that she is hungry but freaks out when mom brings her to the breast because her mind has already associated being in a certain position to feed (think of how baby is held when bottle feed compared to the position when breastfeed). This baby would benefit from being placed in upright football hold or even putting her in a cross cradle hold while allowing her to suckle on the bottle and then doing a bait and switch. 

Like others have said - this may take more than one day to fix. Help mom to understand that the baby is 2.5 weeks early and it may take all this time until she is pro at breastfeeding. 

Hopefully something here will help. 

Jessica Callahan RN, IBCLC
NC, USA

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