Supplementing at breast can be helpful, but it might not teach this baby 
the right thing. Why is this baby inefficient at breast when there is 
enough milk to supply her needs? Is there a motor issue, a tongue tie, a 
shallow latch that makes breastfeeding less efficient?

When a baby is hungry and weak, increasing the flow at breast can help 
the baby get more milk with less work. I love the Lact-Aid nursing 
trainer (available from http://www.lact-aid.com ) (I have no financial 
interest in this device, just find it generally easier for moms to use 
and clean, and more effective at stimulating more energetic sucking). Of 
course, if the baby has a respiratory or cardiac issue (laryngomalacia, 
tracheomalacia, patent foramina, etc) increasing flow will destabilize 
the baby and should not be done.

Some preterm infants breastfeed beautifully, other preterms do better 
initially with a combination of ebm bottles and breast, and transition 
rapidly to the breast once they learn to make bf work. They don't seem 
to do better with at breast supplementation, since supplementers require 
negative pressure to work, and that's what's hardest for preterm infants 
according to many articles by Lau and Schandler.

For tongue tied babies, they generally have a shallow latch (along with 
abnormal tongue movements), which gives them smaller boluses of milk. If 
the frenulum is somewhat elastic, then using a supplementer at breast 
might be helpful to help the baby catch up and then grow well. It does 
not solve the problem, but it does give more milk with a shallow latch, 
and allow baby time to grow. The larger mouth can sometimes accomodate 
more breast without the tongue being able to extend and draw the breast 
in, so tongue tie is sometimes less of an issue as the baby becomes 
larger (6-12 weeks of age). Of course the optimal treatment is to treat 
the tongue tie and stop the restriction of tongue function, but this is 
not available or acceptable in all settings, and may be contraindicated 
in infants with macroglossia or hemophillia.

For babies who are weak and tired, sometimes using a syringe and tube or 
periodontal syringe to "push" the baby a little can work better than a 
more passive supplementer device. Mom needs to be taught carefully to 
respect the baby's respiratory pauses, and to recognize when it's safe 
to stimulate baby to suck and deliver a bolus and when baby really needs 
to rest. This requires a skilled teacher...

Well, I'm sure this is more than you asked for, but it's part of the 
decision paradigm I go through when deciding how to supplement a baby.
Catherine Watson Genna, IBCLC  NYC

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html