There are some studies on the mechanics of sucking and swallowing from the
different feeding devices, some on oxygen saturation rates with different
feeding devices, and some studies on duration of breastfeeding after using
different devices.  What I have not seen a comprehensive review of all the
studies covering different aspects of different feeding devices.  A meta
analysis.  And I think we really need research on HOW the different devices
are being used such as Dee Kassing's paced bottle feeding.  Wouldn't it be
nice to have a whole conference reviewing all of this and then pointing out
the areas of research that are still needed?

Then, I had a thought about a very crucial factor in the whole equation -
the mother baby dyad and how maternal preferences and beliefs play a huge
role that we must take into consideration in our practices. There is a
method used in nutrition education in developing countries that is very
successful.  The same tired old messages of telling mothers what they
should feed their kids didn't really don't work.  There are MANY
constraints to feeding in a way that we know is biologically best for young
children in developing areas. You must look at the whole picture and have
the mother help you to figure out how to achieve the best practices within
their own context.  There is a whole qualitative research methodology
developed around Trials of Improved Practices.  Part of this involves
presenting the choices to the mother of what are the best practices -
letting her decide which of those to pick and then following up to see how
it worked.  The qualitative research done with these women then gets
translated into public health messages for a larger population of women.

In essence, I think many of us naturally do "Trials of Improved Practices"
in our practices.  BUT wouldn't it be great if we could look at the larger
picture and compile this information in a meaningful and consistent manner
so that we can start to sort out a picture of what types of mothers find it
easier to, for instance, use a pump and what types of motherrs find it
easier to use an SNS.  I have some glimmers - but no real data to support
some of my thoughts that I've been sharing and I'm sure all of you do too.

Best, Susan

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