I've only been working with newborns in a hospital for eight years now. Before that is was two and three weekers and older, not in a hospital. We only have babies 36 weeks and older at our hospital's birthing center. I read the suck training articles very carefully in the 80s and 90s and tried some out back then. The newest Breastfeeding Answer Book has descriptions of finger walking on the tongue and also something on a tongue that pulls back. I posted a few days ago about the Actifier because I think it could be a great tool in the future to use with babies such as the one I describe below. I'd like to have the inventors of the Actifier come to speak at a conference - ILCA - LLLI? about the mechanisms of suck as they know them. Here is what I have gleaned from my experiences with new mother baby dyads over the past 8 years. We do finger feeding with either a soft medicine dropper that doesn't hold much more than one or two mls or with a 10 or 20 cc syringe and feeding tube. We never tape the tube or dropper. We place it along side the finger not quite as far in as the finger tip. I have not seen any baby have a problem with that placement. Most babies who form seals around the finger and can create suction are able to obtain the colostrum without our squeezing the dropper. I rest my thumb or have the parent rest his/her thumb on the plunger of the syringe to give ever so slight pressure to get it started. Occasionally there is a baby who doesn't create the suction, so then we very carefully apply pressure to deliver some colostrum. We honor the pauses of the baby. I have found that many babies who do not tolerate forward and downward pressure on the tongue with only the finger in the mouth, tolerate it just fine when they are being fingerfed. As an example, here is what happened with a family. Baby born and reportedly did not root at the breast and did not open well at all. When the mouth opened slightly and any attempt was made to introduce the nipple/areolar complex into the mouth, the baby exhibited a clench response. I went in on a day off just to see them. Mom had pumped some colostrum (about 4 cc). First colostrum alone was finger fed by the Dad who became an expert at feeling the softness of the tongue between the back of his finger (pad side up to palate) or lack of it when baby pulled the tongue back. As the baby developed a rhythmic suck/swallow, the tongue came forward. Then rest of the colostrum, which was quite sticky, was washed out of the bottle and pump flange (lots under the white seal) with a bit of glucose water so that a total of about 10 cc were fingerfed. The parents repeated this at subsequent feedings while allowing the baby to rest between the mother's breasts and be presented to the breast at intervals. Kept there as long as not frustrated. In my book this is an example of allowing a baby's tongue to normalize it's actions while feeding. I often tell moms that when the baby is born with a tongue thrust, the very act of the milk coming in and the chance for the tongue to get into a rhythm helps the baby to learn to suckle properly. This does happen in with many babies, but not with all of them who have a tongue thrust. Some of them continue to thrust for weeks. The next day this baby was able to tolerate the father applying slight pressure while finger feeding and bring the tongue down and forward so that the tip of the tongue rested on the lower alveolar ridge. Throughout the day the baby was more and more able to suck with the tongue forward. When presented to the breast the second morning the baby did root and orally search and tended to open and could be brought onto the breast, but held the tongue back and therefore could not place it under the breast nor settle on and start to suckle. The plan is to continue to fingerfeed the baby colostrum with the downward and forward pressure on the tongue, offer the breast and keep the baby skin-to-skin on the chest, and if the baby continues to come to the breast with the tongue drawn back use a nipple shield to latch the baby. By the end of the second afternoon this baby was more consistently keeping the tongue forward while finger feeding. The parents are very encouraged and hoping that when her milk comes in that the baby will bring the tongue forward to taste some drops of milk expressed on the nipple surface and open and be able to latch with the tongue under the breast. By the way, we also use finger feeding if a baby shuts down after a circumcision and is 'on strike.' By slipping a finger in the baby's mouth, he often will start to suck, and giving a little expressed milk via dropper starts him swallowing, and then he becomes fully awake and the finger is withdrawn and the baby put to breast. We do not flood that baby's mouth with milk. Just a tiny few drops. This also works with sleepy babies who've gone six hours without opening their mouths at the breast. They will take a finger to suck on (never forced on them; if they tighten their lips, we might tap on the lips to see if they voluntarily open, but otherwise do not proceed without a willing baby) drink some milk with the dropper, 'wake up' and latch. Everyone is very relieved when that happens and I haven't seen it interfere in anyway with subsequent feeding. I call all our patients after discharge so I stay in touch with them and get feedback. By the way I wash hands and glove -- we only have non-latex gloves in our unit -- and the parents wash hands thoroughly and don't glove. Mardrey Swenson, IBCLC *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html