Okay, here is the question I have for a patient that my pedi saw yesterday in the office. A two day old infant that has never successfully bf at the hospital but was discharged on ABM. Mother is very discouraged, told she had flat nipples was given shells and sent on her way. The pedi saw the baby yesterday. Bth Wt. 7' 10", today 7'. The infant has good rooting reflex and will open fairly wide. Breasts can be shaped well enough that infant should be able to latch on if sucking good be established. After 15 min of trying to get a latch and using a little ABM on the nipple for encouragement. The most that could be achieved was one little suck and then the baby would push away. Mother was told to discontine all artificial nipples and pacifiers and was sent home with SNS to finger feed and pump breasts. Skin to Skin contact was also reccommended and to watch for rooting and to keep trying to get the baby latched on. Mother did say that the attempts to latch on in the Drs office were the most promising that she had experienced. Mother is to return to office on monday to check weight again and further evaluate. Diaper checks were also explained and only about 15 cc abm in the sns was recommended every 3 hours, instead of the full ounce the baby had been receiving with the bottle. Mother called in today...infant very distressed and not satified with 15cc of sns. Only happy with a finger to suck on constantly. Still will not latch on to the breast. Pedi wants to increase the amount of ABM and even told mom if she has to give a bottle as a last resort to go ahead. I should also mention that the baby is having "gassy" spells that also lead to prolonged crying. Any suggestions out there that have not been thought of...I really feel sorry for this mother. The hospital that she delivered in does not have any real Lactation support and she really got off to a bad start. I really think this is nipple confusion but thats not comforting when you have a hungry frustrated infant to contend with over the weekend.. I would love to hear any suggestions that anyone has since this Pedi is willing to work with this mom and get her breastfeeding! labor3