I want to share (briefly) 2 cases of infants I have recently worked with who
were exclusively bottle fed and who were successfully brought to breast.

Baby #1 born vaginally at term weighing over 7 lbs. to primip mother with hx
of breast implants (axillary insertion) and flat nipples with poor
elasticity of breast tissue.  Baby refused breast from the outset and was
sent home bottle feeding pumped milk.  Mother initiated and maintained good
milk supply for 2.5 weeks, pumping an average of 3-4 oz total each session
(q 3hr sched.)  She phoned for assistance to see if anything could persuade
the baby to breastfeed.  Baby has normal oral anatomy and good tone and
reflexes.  Palate is somewhat high, but baby is vigorous and several oz.
above birth weight.  Newborn small nipple shield with dripped milk to entice
baby was used while mother was positioned in side-lying with baby
skin-to-skin. Careful attention was given to positioning baby so he "led
with the chin" obtaining slightly extended head position, and flexion at the
hips. Baby accepted the shield, and sucked immed.  Swallowing was heard.
Deep breast compression assisted the milk flow.  Test weight after 12 min.
documented 48 ml intake.  Baby accepted the second (less elastic tissue)
breast for only 5 min. before beginning to fuss.  Suspecting baby of tiring,
we discontinued the breastfeeding and topped off with 1 oz of pumped milk by
bottle.  Follow-up in 2 days documented a 4 oz weight gain in 2 days of
primarily breastfeeding with shield.  By now baby will take breast both with
and without shield, tho he tires faster without the shield in place.
Careful instructions were given to proceed with a plan to use the shield
less and less as baby strengthens and nipples pull out.  Post-feed pumping
to be cont. if breasts don't feel well emptied.  Weight checks encouraged
for several weeks until all problems are resolved and shield use d/c.

Baby # 2 was born prematurely by c-sec weighing 4.14 oz.  Primip mother has
inverting nipples, and pp complicated by an infected incision requiring
antibiotics.  Baby refuses breast from the outset, is started on bottles,
and grows well on pumped milk.  She is extremely fussy. I was asked to see
her at  5 wks pp. for "one last try."  She weighed 7.14oz at the time of my
visit, and demonstrated extreme crying and motoric stress cues during
attemtps to breast feed, and while feeding a bottle of pumped milk. She was
brought briefly to breast with feeding tube device hooked up under a newborn
small size nipple shield.  I referred mom back to pedi with description of
baby's physical discomfort while feeding.  Barium swallow revealed moderate
reflux. Baby started on meds.  I made follow-up 7 days later to assess
progress.  Mother reports that she d/c the feeding tube device within a few
feeds, and is just using the shield.  Baby has been exclusively breastfed
for the past 2 days.  Weights indicate baby has grown at the rate of 1.5 oz
per day for the past week, and test weight documented a total feed intake of
72 ml within about 15 min.  when baby d/c feeding and seemed to need to
pause.  Mother reports she feeds smaller feeds more frequently now that she
is no longer bottle feeding, and she is improved in terms of stressed
behavior since starting meds.  Her behavior at breast was lovely, with much
mutual stroking and eye contact.

I urge all LCs who practice in the community to NEVER give up on encouraging
moms to keep trying to bring non-nursing infants to breast.  So long as
mother has good milk supply it is surprisingly easy.  Baby MUST be
beautifully positioned, and if you don't know how to do that, read Chloe
Fisher's work, or better still, watch one of her videos.

Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html