In response to Cheryl Taylor White's question:

"Has anyone else seen a baby that has a gentle suck because they are being
"fed" milk via and SNS and don't have to work very hard for the
milk.....become an avid nurser with a strong suck once the milk isn't quite
as "easily" available and the mom's milk supply then abounds with the
stronger suck where it was a battle prior to that?"

Yes, I have observed the gentle suck on the SNS. In the practice where I'm
training the response to a "gentle suck" is to evaluate the latch and work
on that if its not adequate and to evaluate the tube size and placement.
The first focus is on improving the latch so in cases where the mom cannot
achieve an adequate latch, the SNS is not used until she improves her
skills. The tube size is selected based on the infants behavior, whether or
not they have a vigorous rhythmic suck.

I haven't seen the battle to increase the milk supply BUT I think that this
might be because the practice is very agressive in figuring out the
appropriate level of challenge for the infant and mom. Follow up is very
frequent (every few days) and changes are made to challenge the infant
more. Sometimes infants do suffer a regression in their oral skills if they
are challenged too much too soon.  For this reason, the practice does try
gradual changes.

I would really love to find funding to do a study on the SNS, because the
practice has made two changes in the use of the SNS that seem to make it
easier to use.  The reason why the practice changed the use of the SNS was
because they thought their method improved the latch. I have a hypothesis
that one of the changes also permits the infant more control over the SNS
flow, and hence may make the flow less like that from a bottle and more
like that from a breast. One could argue that the high graduation rate from
the practice is due to the experience and skills (and probably is in good
part).  But if the method of using the SNS really is better, knowing that
some changes in the use of the SNS might make it easier to wean infants off
the supplementer would be helpful for those of us who are just starting
out. Of course, those of us who are starting out most likely would not be
seeing the volume of high risk infants seen in this practice.

I wish my supervisors were online, because they could be far more
articulate, but they are SOOOOOO busy.

Susan Burger, PhD, MHS

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