Brenda,
       You ask about how to help premies transition to full breastfeeding.  I
have worked with a lot of premies over the years who have been discharged and
now moms are trying to get to exclusive breastfeeding (as in no pumping or
supplemental feeds--either ABM or expressed breastmilk).  I have found that my
method of bottle-feeding (Feb. 2002 JHL, "Bottle-feeding as a Tool to Reinforce
Breastfeeding") works well in many of these situations.  This method of
supplementing allows the baby to take what he needs, without overfeeding, so mom
doesn't have to decide for the baby how much supplement he needs.  It also lets
moms easily see when babies are doing better at breast, because as they take
more from the breast, they just naturally leave more in the bottle.  And the
style of bottle nipple encourages the baby to use his mouth in a manner very
close to breastfeeding, so this type of bottle-feeding is less likely to cause
nipple confusion.  The tricky part of the method when working with premies is
choosing the nipple flow-rate.  I find that most 5-lb babies can handle the
slow-flow nipples.  But I caution moms that if the baby consistently takes longer
than 30 minutes to finish the bottle (and baby is still exhibiting hunger
signs--not that mom is trying to force a set amount of supplement into the baby),
then the slow-flow may be too taxing for the baby's current abilities and a
medium-flow may be better for the time being.  However, a nurse who works with
the premies still in hospital has told me that sometimes the babies desat (lose
oxygen) when using the medium-flow, so then she goes back to the slow-flow
anyway.  Premies weren't meant by nature to be orally feeding yet, but that's
how we have to feed them.  So there may not be a perfect method for feeding
these little babies.  It's best to watch each baby carefully and see what he
responds to best.
       Dee

Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA

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