I read with great interest and some curiosity Jack Newman's comments on
pediatric Occupational Therapists being "wedded" to bottle feeding. This is
an interesting comment.  I too wish that OT's spent as much time studying
breastfeeding as they do bottle feeding. I personally feel that breastfeeding
is an infant's first ADL (Activity of Daily Living, for an American adult
that would be equivalent to teeth brushing or dressing). And if a newborn for
whatever reason cannot breastfeed, then he/she needs adaptive equiment
(bottles and nipples) to survive (walking aids such as canes, long handled
reachers, bedside commodes, special silverware, wheel chairs, etc are
examples of adaptive equipement for adults). And all other options should be
exhasted before ordering adaptive equipement. Some adaptive equipment is only
needed for  a short time (we don't begrudge President Clinton for using canes
after his knee injury, do we?). That is how I personally feel about bottles-
use them only if necessary, and for as short a time as possible, until the
baby can go on the breast 100%. Now although I graduated from OT school in
1979 and it was  long ago, I can't recall learning ANYTHING about cup feeding
in OT school. We did learn gobs and gobs of very  boring theory. The
instruction in oral feeding that I recieved came about by individualized
on-the-job training by other therapists, and from course work (extensive,
over many, many years) I took on my own. NO OT is wedded to bottle feeding. A
hand therapist or psych OT or even an adult rehab OT knows NOTHING about
bottle feeding, (unless that is how they fed their kids) and an OT who has
breastfed probably knows more about breastfeeding than bottlefeeding.  I
don't think OT's love bottle feeding any more than nurses do.  Are NICU
nurses wedded to bottle feeding? We (OT's/PT's) are  committed to solving
feeding problems and FEEDING THE BABY. Many if not most OT's may be  ignorant
about the intricacies of breastfeeding, but when I lecuture to OT groups, the
majority (if not all) of the women who are mothers have breastfed their
children, and are anxious to learn more about how to help breastfeeding
mothers. The infants we are treating, are, by and large, probably moderately
to severly involved to have required OT services as young babies in an
outpatient setting.  Do you think these mom's are working on breastfeeding?
or are interested in being helped to breastfeed? Usually these moms are
desperate just to get the kid to eat orally and off the G-tube.  Or are we
talking here about NICU OTs? (of which I am included). In this case, we work
under specific orders from the neonatologist. The orders are very clear - "PO
34cc E20 with the OT" . It takes a very strong professional to pipe up "Can
the Mom try breastfeeding today?" under those circumstances. I have been told
"over my dead body" more times than I would like to remember.  If the
neonatologist wants the baby to breast feed, or even to try or to  practice,
 they should write that clearly in the orders and call the LACTATION
CONSULTANT! If the neonatologist just wants the baby to feed (and doesn't
care how), they call the FEEDING specialist, who may be OT, PT, or Speech
therapist, depending on the unit. The therapist follows the MD's orders.  In
the ideal world, the OT, PT or ST will also be trained to help brestfeeding
moms, and the LC will work WITH the feeding specialist. NICU babies usually
don't have a quick fix, either with the bottle or the breast. If it appears
that OT's "spend their time trying to get babies with various problems to
learn to bottle feed", it is because that is what the neonatologist has
ordered. I know how hard it is for a parent to feel intimidated by super
-professionals, but the parent MUST advocate for their own child, and that
includes speaking up and saying loud and clear: I WANT TO BREASTFEED. HELP
ME.  And saying this to each and every person taking care of that baby,
until, sometimes, the staff gets sick of hearing it but knows that
breastfeeding is important to this mom. So please don't blame the OTs. You
can always refuse to work with a professional you disagree with, or request a
different one. Speak up and ask for help breastfeeding. In this day and age,
I think we must all advocate for our own healthcare.

Debbie Rabin, OTR, CLC
Los Angeles, CA

P.S. (where I don't have any slugs in my garden, and we can grow tomatoes
year round)