I've gotten almost a month behind  between conferences, vacation and a hard
disk crash (ouch!).  Hope it's not to late to respond to this thread begun
by Debby:

>Where we fall apart is with problem feeders.  There seems to be a wide
>gap between opinions on what to do next.
>We need a protocal that we can introduce to our peds so we have a
>systematic way of dealing with problem or reluctant feeders.

I heartily recommend reviewing Karin Cadwell's wonderful commentary article
in the March 97(I think) issue of Journal of Human Lactation.  In this
article, Dr. Cadwell presents an in-house quality improvement method for
situations such as your reluctant feeders.  She includes sample "fishbone"
diagrams, offering possible contributing factors to breastfeeding problems.
Such a fishbone diagram could be adapted to your situation.  You could
make photocopies, and ask staff to grab a highlighter, and quickly circle
all the appropriate conditions for each of the next 10 or 50 or 100
reluctant feeders. A mini study!

When you have several fishbones collected, pull together a
multi-disciplinary Quality Improvement Committee.  (You may find that some
hospital staff members are more interested in serving on a Quality
Assurance committee than on a Breastfeeding Task Force.)  The Quality
Committee may discover some interesting things about the reluctant nursers
at your hospital.  Your hospital might also be well on its way to building
your Baby-Friendly team.  This method will not directly answer your
protocol needs, but it might facilitate their development.

Best of luck to you!

Cindy Turner-Maffei
Massachusetts, USA