Dani-
One question that I have about a premie's sucking needs is this: just how
much sucking would he have done if still in utero? I know that some babies
suck voraciously on anything, but do all babies suck a lot in utero? I
honestly don't know the answer to this question, but I feel it should have
some bearing on our thinking regarding sucking time in the NICU for these
babies.
As for finger over bottle feeding-- you are right in noting that the finger
is hard like a bottle. The difference that I see is that the finger can be
more accurately placed at the juncture of the hard and soft palate where a
breast correctly belongs, whereas the placement of a bottle nipple is
haphazard and often too shallow. Secondly, fingerfeeding provides feedback to
the feeder as to the quality and coordination of the suck. If necessary, a
little subtle prompting can be done to help the suck pattern. Finally, when
finger feeding with a periodontal syringe, there is much greater control of
the flow of milk vs a bottle; it can be given in burst of milk suck as is
obtained by breastfeeding, whereas bottle feeding tends to result in a more
steady stream that must be controlled by the baby, most often with his
tongue. When we are discussing apnea and O2 sat rates, I would think that a
feeding more controlled by the feeder would be advantageous and less risky,
as bottles tend to be overwhelming.
On the other hand, after placing this in my "to send" file, I read Jon's
comments about the molding of oral cavities by various objects, and that is
worth taking in to consideration with this topic, too. I am wondering if the
haberman feeder might be an excellent alternative--- it is supposed to allow
baby to do more stripping action, giving him more control; the flow is
adjustable, and it is more malleable and perhaps less likely to alter the
premie's soft oral structures. Currently it is recommended more for cleft
palate babies, but should we consider this as a more primary alternative to
the breast? I'd be interested on the expert's thoughts on this.
I have no expertise here, but these are my comments after much critical
thinking.
-Lisa Marasco, BA, LLL, IBCLC
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