Ann,
Could be a shot in the dark here, but I'd be more inclined to think that the 
baby might be objecting to the flow rate of the SNS. You don't say why the 
baby was a poor nurser to begin with.  Using a paced feeding technique, with 
baby in a sitting position, and a truly slow- flowing nipple would be my 
choice for a baby that was borderline failure to thrive at 23 days. With mom 
on a good pump. But if mom is truly opposed to a bottle I'd go back to 
fingerfeeding with a syringe and tube or a periodontal syringe.  Once the 
baby gains some weight it may be strong enough to nurse appropriately. 
Perhaps using a nipple shield as a transition tool, if it seems nipple 
confused.  Without enough calories, baby may not have the energy to nurse 
appropriately.  I've seen a few babies where I couldn't even do a proper 
assessment of their problem until they got some calories into them in a 
safe, acceptable-to-the-baby manner. If the SNS is used, I'd try putting the 
baby completely on his/her side so milk can be allowed to spill out the 
corner of the mouth if baby is overwhelmed by the flow.
Good luck,
Anne Grider, IBCLC
Private Practice



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