Kathy,

You wrote:

< I wonder about trying a SNS underneath the sheild...but I didn't want
to throw
too much at this mom all at once.>

Perhaps you might even want to consider using a Hazelbaker fingerfeeder
to supply the tube beneath the shield.

I once had a mom who had a totally different situation: babe was fine
after frenulum was clipped, even though he got hooked on both the rubber
nipple and fingerfeeder and rejected her because mom had large flat,
"pithy" nipples with very deep reservoirs.

But she was using the FF much of the time to follow Rule #1, and as we
got him beginning to transition to the breast, a shield was part of the
process.

Since the equipment was all there in the house, I came up with the idea
of running the tube under the shield so we could give that particular
baby a bolus to stimulate him to keep sucking.

For your baby however, with the cleft and fatigue interfering with
suction, the manual bolusing capability according to the baby's fatigue
etc. might have something to recommend it.

At any rate, the mom found this pretty easy to handle, and once in a
while, dad helped out. Then again, no one would even have to handle the
SNS if you elevate it to get it to deliver the desired flow rate. I can't
remember how efficient the SNS "bolus" capability might be.

Even if you choose to use the SNS, I don't think it will be as
complicated for her as usual, because the shield holds it in place pretty
well, and you don't have the hassle of taping, or worrying where the tube
ends up in the baby's mouth.

Just something to consider.

Jean
****************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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