Offering the breast "for dessert" helps. The baby gets most of his
bottle, then is encouraged to latch onto the breast for dessert.
Using the baby's built in reflexes for self attachment can work, I've
had success with having mom distract baby with toys and funny sounds,
and as part of the "play" place her nipple on his philtrum (that ridge
between nose and upper lip). Very often the baby will open wide and
latch. This has worked with babies up to about 4 months old. She can
also spend lots of skin to skin time, with baby close to her breast when
drowsy, some babies will latch then.
Bottle bait and switch is another trick. Mom bottle feeds baby close to
the breast wearing a nipple shield, she slips the bottle away and slips
the nipple close to his mouth. Often babies will latch this way.
I rarely have to recommend the "tough love" breastfeeding lesson (mom
feeds baby by cup or spoon only, keeps baby skin to skin on her chest in
between. Baby self attaches. May cry and complain, but keeps self
attaching until he or she actually starts sucking. Sometimes that's the
only thing that works. I stay with the mom, encourage her to speak
soothingly to the baby, stroke the baby, and we talk quietly. When baby
gets too upset, we give a little milk by spoon or cup, and then put the
baby back on mom's chest. I've used this 3 or 4 times, and it takes a
good hour or two. Once the baby breastfeeds, the mom just offers the
breast for the next few weeks until breastfeeding behaviour is
re-established. I ONLY do this when mom has a full or nearly full milk
supply, and baby has nothing that prevents them from breastfeeding,
other than inexperience. One baby was a relactation case (mom had HELLLP
and was in intensive care after birth), another was a baby who had
required a frenotomy and was bottle and fingerfed for the first month or
two and though her suck had normalized, she wasn't doing this breast
thing. Both never looked back once they started breastfeeding. For the
other kids, it was a longer, harder road.
Catherine Watson Genna, IBCLC NYC
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