I have no real knowledge about goat's milk, etc. and not a whole lot about adoptive nursing. But I have seen enough problems at WIC to mention the importance of emphasizing a SLOW rate of feeding, with pauses between pulses. This is helpful in sorting out whether it is the liquid being fed, or perhaps the manner in which it is being fed that is causing problems. 1) the preformed nipple with one hole often squirts milk straight to the back of the throat, stimulating gag reflex and/or competing for space at the back of the nasopharynx, interrupting the path of air from nose to larynx. 2) this is especially true if the baby has a strong sucking reflex. 3) if liquid has been warmed, this makes the flow faster and more forceful. 4) babies responding to this often appear to be "chuggalugging" it down, which is misinterpreted by adults as proof of their hunger or "greedinness". 5) it is in fact a stress reaction caused by fear of choking, and resultant inability to coordinate breathing, sucking and swallowing without anxiety. 6) it ends up a viscious cycle because the baby's coping effort often manipulates the rubber nipple more frantically, increasing the force and flow rate. 7) poorly coordinated suck/breathe/swallow has even been shown by electronic monitoring to slow the heart rate, at least in prematures. 8) this whole process can result in overfilling the stomach, long before the 20 minutes that the first few cc.'s need to complete the digestive process, be absorbed, change the blood glucose level and deliver that signal to the satiety center in the brain. 9) This seems to bear a certain resemblance to the cycle triggered by severe OALD (overactive let-down). I have had success in explaining this slower "pulse/pause" method to parents, cautioning them to keep the baby as upright as possible, let them have a maximum of 4-6 sucks, tilt the bottle down so the nipple is empty while allowing the baby to catch his breath and relax his fists and breathing efforts, and repeat this several times, while calmly reassuring the baby "We won't let you starve, or choke etc. etc." Saying these words reassures the adults at the same time as the tone of voice reassures the baby. I recommend that they take frequent "burping, cooing and rocking" breaks, after the initial "pulse/pause/pulse/pause" sequences, dawdling long enough that only 1-2 ounces or less has been fed by 15-20 minutes. The satiety feeling (not due to volume consumed but blood sugar changes) will take over and the baby will usually slow down and stop on his own, at a much smaller volume than when consuming it rapidly. I suspect this imitation of "MER, trickle, MER, trickle" rate, also helps to reduce the danger of "nipple confusion", which I am now convinced is at least 50% flow rate confusion. Some parents (and professionals) simply cannot or will not cope with alternate feeding methods when the baby is not feeding adequately from the breast. If the bottle simplifies their life, they may at least be open to adjusting the flow rate of any necessary supplements. If this is too elementary, I apologize, but I have seen it happen so often to parents, grandparents, babysitters, etc. who have the best of intentions, I thought it worth mentioning. Jean ************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html