A few suggestions: Encourage mom to offer the finger in a way that 
requires the baby to latch onto it- finger across the lips (like a 
shushing gesture) but with the fingernail against the philtrum so the 
baby opens wide, then bend the finger slightly so the area under the 
fingernail touches the baby's tongue. This will encourage the baby to 
bring the tongue down and out to grab the finger, the same way the baby 
should grab the breast (oral grasp with the tongue). Then mom can let 
baby have the finger. She may need to "cheat" for him (accept successive 
approximations) at first, but he should catch on. That's the first step.

Then, have her try fingerfeeding at her bare breast, so the baby calms 
down about being there. Then try transitioning him to breast once he's 
had some milk in his favorite way (and do have her use the tube at the 
breast, since her supply is low, he won't get much reward otherwise). As 
he feels like the breast works for him, he'll begin to be happier to be 
there.

Enjoy your vacation!

Catherine Watson Genna BS, IBCLC  NYC  cwgenna.com


On 6/17/2012 11:25 AM, Priscilla Tansley wrote:
> Dear Wise Ones,
>
> I need some quick advice and please send it to me at [log in to unmask],
> as I am nomail right now (vacation starts tomorrow!.)  Last evening I met
> an 11 day old infant who was born at 36.5 wks gestation.  He had latched
> very little in the hospital prior to discharge.  Sadly I hadn't gotten to
> help them prior to their discharge and had met them only in passing.  They
> left the hospital finger feeding and that is now the only way he gets his
> expressed breast milk and some formula.  Mom is extremely stressed and has
> been sleeping only 2-3 hrs/ night as she is worried that the baby will stop
> breathing, etc.   She is a primip.  Her milk supply is faltering and she is
> now pumping half as much (only 6 oz/day now) as she had been and needing to
> use more and more formula.  She is heartbroken about using formula and
> becoming totally discouraged with the dwindling amounts she is getting when
> she pumps.  She reports that she hates pumping, finding it painful,
> although I couldn't see any broken areas on the nipples.  She has nipples
> that erect and pliable breast tissue.  Breasts don't exhibit any of the red
> flags for insufficiency.
>
> When the baby was brought to the breast, he instantly got very upset and
> arched himself as far back from the breast as he could.  We teased him with
> a taste without success.  We tried a nipple shield, with some ebm expressed
> into it and still no success.  Next we taped a tube to her breast and we
> had some slight success, in that he latched a couple of times and fitfully
> got about a half ounce.  He was obviously not satisfied with feeding this
> way.  He does have a small tongue tie and most often has his short tongue
> curled up and back in his mouth.  Finally, we gave in and gave him the
> finger and the tube and he relaxed and sucked down the rest of the 2
> ounces.  He is gaining fine and was nearly back to BW at 8 days or so.
>
> My advice to her was to make sleep a priority.  When I wasn't able to see
> her the day before, I told her to take a babymoon, naked under the sheets
> for the next day, which it sounds like she did some and that the baby
> nursed a little at the breast, after he had already eaten from the finger,
> once.  In fact she said he'd only nursed at the breast 7 times since
> discharge and it was always after he had just eaten (she's dessert!)  My
> feeling is that he developed an aversion to the breast and that she needs
> to give him a break from it so that he can forget his aversion.  I wasn't
> sure how long to tell her the break should be.  I also gave her advice to
> keep the pump pressure comfortable (I think it was a Pump in Style) and how
> to maximize her letdowns when she pumps. She is lucky to have a very
> supportive, involved husband who is going to try harder to help her get the
> sleep she so desperately needs. I suspect that her anxiety and sleep
> deprivation are at the root of her diminishing milk supply, as she sounds
> like she is pumping every two or three hours.  I'm not sure why I didn't
> think of it, but maybe it would make more sense to transition the baby to a
> bottle and then try to move him to the breast or a nipple shield.  Anyway,
> I am very interested in hearing from anyone who has worked with a finger
> addicted, breast averse baby and successfully transitioned them to the
> breast.  I am hoping to call her later tonight from work with more
> strategies.
>
> Priscilla Tansley RN, BSN, IBCLC
> (who has the pre-vacation jitters and hasn't slept very well herself, in
> the past few days!)
>
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