Hello, Laura.
       It is quite unusual for a 4-month-old to accept an SNS or Lact-Aid
tube on the breast when it's never been there before.  They either want to play
with it, or they get mad at it's being on "their" breast and try to rip it off,
but either way, they are not nursing.  (It's a different story if the tube
has been there since the baby was very young.)
       I'm sure you know lots of tricks for increasing milk supply.  I want
to suggest a trick for keeping this distractable baby at the breast during
feedings.  This often works well for that 4-8 month old who is afraid he will miss
everything if he keeps eating.  The problem seems to lessen by the time baby
gets older than 8 mos (usually) as baby by then seems to realize that the
world will still be there after he finishes eating!
       When baby is nursing in the cradle position, and he hears an
interesting voice/noise, if he tries looking out the corner of his eye, all he can see
is the boring white ceiling!  So he has to pop off to find out what's going on
or to say "Hi" to dad or sibling.  What I'm going to describe is *not* a
"go-to-the-mall" position because it's not discreet.  But it works very well at
home.  Suggest to mom that she try positioning the baby sitting up at the
breast.  It works even better if mom can sit sort of sideways in her chair.  Now
when baby hears an interesting noise and looks out the corner of his eye, he can
see a lot of the room (and what's going on in it).  Just be sure to keep older
siblings playing in the half to two-thirds of the room that will be in the
baby's line of sight when he looks sideways while breastfeeding.  If baby
doesn't feel like he's missing something, then often he will continue to nurse
because he can watch everything that's happening and still fill his tummy.  (Remind
Dad to come into baby's area of sight before speaking!)  A lot of moms have
found this trick to be very helpful to keep baby "on task" for feedings during
those very distractable months in the middle of the first year.
       Dee Kassing, BS, MLS, IBCLC
       Collinsville, Illinois, in central USA (near St. Louis, Missouri)

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