Regarding this discussion of use of bottles for assessing sucking or  feeding 
I want to add my observations and research.
 
First, babies are natural at breastfeeding not at bottle feeding.  I  am not 
talking about the babies that have problems just in general, natural  terms.  
There is the assumption that babies do fine with bottle feeding and  that 
EVERYONE knows how to feed babies with bottles, so therefore there needs no  
education on how to perform this task.  This is the research I have been  doing on 
my own for the past several years, looking for teaching of bottle  feeding in 
infants.  This is what I have found.
In the past couple of years members of the lactation field have done some  
work on "paced bottle feeding" and this seems the most appropriate place to  
start.  We in the lactation field should be the experts on normal feeding  of 
babies.  The companies that make bottles and formula there is no  instuctions or 
research.
 
If folks have not seen Barbara Wilson-Clay's DVD from her and Kay Hoover's  
latest issue of "The Breastfeeding Atlas", I highly recommend it.  She  shows 
and describes paced bottle feeding and one can easily see the differences  it 
makes in a baby when they are more in control of the flow.
Another resource that I am only partially knowledgeable in is NOMAS.   What 
this stands for is at work and I am at home.  I know there are folks  here on 
LACTNET that have attended their workshops and please chime in.   This workshop 
deals with feeding of neonates and looks at bottle feeding.   One lecture I 
heard who described what she learned from NOMAS was that if the  baby is in 
rapid sucking this is non-nutrive sucking so one would want to tip  the fluid out 
of the nipple so the baby is not taking in a bolus because they  are not 
anticipating to coordinating a swallow.  The person feeding the  baby needs to 
watch for the baby's readiness to change to the long, slower  drawing suck and 
this is when to allow milk into the BOTTOM HALF of the nipple  so the baby can 
take an amount they can control.  
 
I have been trying to teach the nurses and parents how to properly bottle  
feed their babies.  I talk about waiting for the baby's readiness and  rooting.  
The baby needs to be sitting up and the bottle will be slightly  tipped back 
with the teat toward the baby's palate. (This is well  demonstrated in 
Barbara's DVD.)  Then watch the baby's sucking pattern to  determine when he/she is 
ready to take a swallow.  I review signs of babies  that they are not handling 
the feeding and need a break.  These include  milk spilling out of the sides 
of the mouth, coughing, choking, hic ups, hands  spaying, baby struggling, and 
eyes starting to fade shut.  
I have written to Karen because I think we are on the same path and will  try 
to reach her again on work she has done.
 
One more note on bottle feeding training baby's suck.  In Barbara's  DVD she 
does show that with the pulling out of the nipple when giving the baby a  
breather, this break of suction does help them develop a better and stronger  
suck.  Barbara please chime in on this anytime.  
 
Do others agree with the observation that health care providers and the  
public just assume that everyone knows how to bottle feed a baby?
Bottles are a tool and very ingrained into society, we just need to learn  
how to use them properly.
 
Ann Perry, RN IBCLC
Boston, MA

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