Jennifer asks: Can I expect this baby as he gets stronger to become more
effective at the
breast?  Any words of wisdom to share with this mom to help her confidence?

Jennifer, you can reassure this mother that, absolutely, as this baby nears
term corrected age his ability to breastfeed effectively will improve and there
is no reason to think that he will not be able to totally feed at breast. In
our center we take it as a given that a baby less than 38 weeks may have some
problems breastfeeding.  At 35 + 4 weeks gestation most babies have neither
the stamina nor the strength to totally breastfeed. Several things help the
process along. First is an ample milk supply--we're happy when our moms are
making 25-30 oz. per day. This is probably much more than this baby takes at this
point but the more milk the faster the flow and the easier it is for baby to
drink it. A shield often helps a premature baby, but sometimes we meet a premie
who nurses better without it. I always try without a shield first and only use
it if baby keeps popping off the breast without it. You also need to make
sure the shield fits correctly--baby needs to get far enough back on the shield
to stimulate a MER. I also find breast compression invaluable with these
smaller babies to enhance flow. And starting on a pretty full breast helps milk
transfer if baby has a weaker suck. At this point I would teach the mother to
recognize nutritive v non nutritive sucking. If sucking is non nutritive--flutter
suck without deep jaw excursion and a pause I would limit time at breast to
15-20 minutes for now--just so he doesn't forget how to latch. Mom needs time to
pump and bottle feed and since I've found that high supply has the strongest
correlation with a premie's ability to breastfeed well I would stress building
and maintenance of supply.

Moms of premies worry about weight gain and rightly so. Because of this they
need lots of reassurance and encouragement that breastfeeding will work for
them. Often as they see nice wt. gain on  the bottle  they give up on the
breastfeeding. They may pump and bottle feed for awhile but this becomes tedious, so
the duration of breastfeeding decreases.This is the point where she needs
lots of support. In the next few weeks as this baby gains wt. and matures his
ability to breastfeed will increase. Mom will need close follow up to transition
to full breastfeeding. I find test wts on an accurate digital scale can really
reassure mothers that baby is getting enough from the breast. The other thing
that is important in the transition to full breastfeeding is frequent wt.
checks (every couple of days). This reassures both mom and the HCP that things
are going well. We have moms fully breastfeeding premies in the hosp. who go
home and give up because they lose confidence.

This mom is lucky to have you as a doctor Jennifer. Your support and
reassurance will be invaluable.

Kathy Boggs, RN, IBCLC

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