We are two hospital based IBCLC's who have a situation we so far
 have not been able to solve:
       First time mom very motivated to BF.  In the hospital, baby was
 sleepy and reluctant to nurse, but did latch and suckle a couple of
 times.  We saw them back on 2nd day after d/c.  Baby had not latched
well
 or suckled for more than 5 min twice in first 24 hrs at home.  Weight
 down about 11% from b/wgt; mucous membranes moist, some wet diapers, no
 stool in past 24 hrs.; sm. lt. brn stool with rectal stim using
 thermometer at office visit. LC called pediatrician who said to go ahead
 and feed with ABM (soy) if no EBM available. Breasts firming but no
 significant amt obtained with pump.  SNS hooked up with soy, but could
 not get baby to nurse for more than seconds at a time after an hour of
 trying.  His mouth is rather small and jaws are clenched.  Ended up
 showing mom how to finger feed.  She liked this option and went home
 prepared to pump and finger feed after first trying to latch baby on
 breast, then breast and SNS. Encouraged her to spend time skin to skin
 with baby.  By the next day she called and said things were "going
 better". Baby did latch some, and nurse for short bursts, but she was
 continuing to finger feed; and getting some EBM.  Home nurse with LC
 experience (not IBCLC) spent 2 hrs with them, and said nursing was a
 little better.   A week later Mom called (today) to report they are
still
 not nursing.  In fact, things are worse.  Reports plenty of EBM, but
baby
 won't latch.  Still finger feeding. "He sucks fingers, rubber nipple,
his
 fists, everything but my nipple."  Asking about silicone shield.  angers
 explained.  Wants appt. with us in next couple of days. We have
exhausted
 our ideas.  Please HELP if you can.  Would you try the shield (with
 warnings / consents as described in Auerbach and Riordan) or is there
 something we haven't thought of yet?  Thanks in advance.  Anne and
 Margaret in VA