During the Wolf and Glass conference last year, I believe it was, they recommended using a nipple shield at the breast with a #5 French feeding tube threaded between the shield and the breast. The other end of the tube goes into a bottle with either milk or formula in it. Because some premies have difficulty maintaining suction, the nipple shield helps the premie stabilize the breast in his mouth so that he's not as likely to slip off. The feeding tube augments mom's natural flow so baby doesn't fatigue before getting full. The Mom (or a helper) can raise or lower the bottle holding the supplement to adjust the flow of the milk according to baby's ability to manage the flow at the breast. If a mom's flow is augmented in this way, however, it's important to monitor baby's breathing patterns to be sure he is able to suck/swallow/breathe adequately. The tube/shield method is most recommended for babies who are generally slow feeders, have poor endurance, and/or weak suck. A baby who is having problems coordinating her s/s/b would NOT do well with this set-up. Whereas the natural flow of breast-only allows baby's breathing and oxygen levels to "catch up" between MER's, the feeding tube (especially if the bottle is raised above baby-height) creates a constant flow of milk which may not be in some baby's best interests. Too fast of a flow can create feeding-induced apnea (lack of breathing). Remember, premies in particular may not cough while choking, so be vigilant while introducing this method, and follow the baby's responses. This set-up also works beautifully for babies who are working to get back to breast and prefer the faster flow that comes from a bottle, especially if mom's milk supply isn't optimal (yet). The first few times this is used, the bottle can be higher; then, as baby adapts to being at the breast, the bottle can be lowered further and further so the flow slows more and more until the tube can be removed (assuming mom is concurrently working on her supply). HTH, Debbie Gillespie, IBCLC, LLLL Tempe, AZ *********************************************** 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