Another option on paced feeding is to put the baby on side and at 45 degree angle. I have noticed that in younger babies, sitting them upright and putting pressure between the shoulders can sometimes cause them to start arching and chewing rather than sucking on the bottle. The tongue is attached by ligaments to the hyoid bone which is attached to the spine, shoulders, etc. More arching is not helpful with sucking.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of K. Jean Cotterman
Sent: Monday, January 20, 2014 1:11 PM
Subject: Re: low supply after comp feeds... What to do??
Different nipples flow at different speeds, and some, in fact do flow faster than others, depending on the size of the holes, and increasing if she has boiled the rubber nipple. If she wants to use a bottle for complementary feeds for this premie, then using "paced bottle feeding" (a term that I understand that speech therapists and others reserve for different use) as in Kassing D, Bottle-feeding as a tool to reinforce breastfeeding, J Hum Lact 2002 Feb;18(1):56-60 may help. It involves positioning baby on one's lap sitting nearly upright, with the bottle nearly horizontal so that gravity is not speeding the fluid into the throat, forcing the baby to swallow rapidly or choke-after it comes out of the rubber nipple, and then inserting frequent pauses, with bottle tipped down (nipple tipped up) for a moment, to mimic variable speed of milk in breastfeeding so baby doesn't become "hooked" on rapid or constant flow rate.
More frequent milk removal, spending just 10 minutes or so, at more frequent intervals (removes FIL (feedback inhibitor of lactation) and releases back pressure on lactocytes which effects efficiency of parts of the lactocytes (alignment of Golgi complex, etc.as in a factory assembly line for the milk formation within the milk making cell), is very effective in building supply, as milk production is faster in the first hour after milk removal, slower the second hour, slower yet the third hour etc.(Swedish milk curve described by Egnell). Diane Wiessinger has a wonderful sheet for mothers to explain this.
I also had a mother with a completely different situation who used the homemade supplemental nursing system a la Jack Newman, to administer extra breast milk or supplement as baby was nursing. I bought a sterile catheter from my veterinarian, and mom cut a hole in the rubber nipple to insert the catheter from the inside of the nipple. The "far end" of the catheter is somewhat larger, and was inserted beneath the surface of the milk in the bottle. She inserted the catheter slowly into the side of her baby's mouth near the nipple when she felt it "time" in some feedings, and the vacuum then slowly started to draw fluid through the catheter into the baby's mouth, alongside the mother's nipple so the baby didn't detect the difference.
These are a few things I have found helpful for different mothers with specific problems or risks, over the years.
K. Jean Cotterman RNC-E, IBCLC
WIC Volunteer LC Dayton OH
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