Ann Slaughter writes: Once an infant is about 1500 grams or about 3-3.5
pounds they commonly =
start giving feeding cues, some earlier than others. These feeding cues =
are just the beginning. We start with extremely small pacifiers, and =
advance to oral stimulation with tube feedings. As the infant grows and =
continues to demonstrate an interest in oral feedings, without other =
complications, we attempt bottle feedings. A baby may know how to suck =
and breath but it is the three fold action of suck-swallow-breath that =
give many babies problems.
The approach in the NICU where I am a lactation consultant is quite
different. Babies are fed by tube long before they show feeding
cues--sometimes just a few ml's per day to prime the gut (of course
preferably with mother's milk). By the time they are showing their earliest
feeding cues--sometimes as early as 30-31 weeks--we assist mom in putting the
baby to breast. Baby may latch and suck one or two times. We consider this a
successful first bfdg session. At first we try one or two sessions per day
when infant is awake and showing feeding cues. Often we use a nipple shield
since this facilitates latch with these tiny babies who do not have the
muscle strength to elongate and hold the nipple in their mouths. When we see
nutritive sucking we teach mothers how to do test wt.s. Believe me this
keeps the bottle away. If we can show, for instance, that a baby has taken 15
ml from breast and his normal feeding is 30 we give the rest by gavage
(indwelling tube). Our goal is to have many, many breastfeeding sessions
before baby ever has to have a bottle. As discharge draws near some babies
are fully breastfeeding and some are not. We individualize the plan for each
baby. Mothers with ample milk supply (even overabundant) seem to have more
success bfdg premies because the babies don't have to work so hard to get the
milk. Babies that were very small (23-24 weeks) can have many problems
including feeding problems--we often work with OT's to individualize feeding
plans for these babies. Our major goals are to maximize milk supply,
establish bfdg long before bottles are ever introduced, to use slow flow
bottles when we do use them and to minimize those. We have seen that even
small premies can totally learn to breastfeed before they ever have a bottle.
Many of our babies bf for weeks before they get a bottle. Much credit for
this goes to a supportive neonatologist in our step down unit, a staff who
supports family centered care and in the situations where it works well a
very motivated mother. When our mothers are pressured to give bottles we try
to help them evaluate whether it is a wise idea. If baby is nowhere near
discharge why push it? If full feeding is the only thing keeping the baby in
the hospital and it doesn't appear that the baby is going to be able to
totally bf for some time then we help mothers to devise a plan where they
will bf, pump, and supplement by bottle until the baby is able to totally bf.
Didn't mean for this to be so long!
Kathy Boggs, RN, IBCLC
Mountain View, CA
Kathy Boggs, RN, IBCLC
Mountain View, CA
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