Paula, I just attended a seminar dealing with gastric reflux and hyperlactation that may provide some helpful ideas. Stimulating breastmilk by pump often (deliberately) produces an overabundant milk supply since the infant's demand is not what's regulating the supply. Overactive letdown reflex is almost always present in the case of overabundant milk supply. This, and it's tendency to overfill the baby's tummy, and not the "thinness" of breastmilk, is more than likely one major source of the baby's problem. This is not to say there might not be other problems in addition, but it is sad to see that this aspect has apparently been so mismanaged. Sounds like sacrificing breastfeeding on the altar of ignorance, as Dr. Jack would say. At the very least, the breastmilk could have been given by a slow-flow nipple or alternate feeding method. The Medela thin silicone nipple shield, small size for a premie, discussed very positively on Lactnet the last few days, is an excellent tool to deflect the force of an overactive let-down reflex and slow the flow so the baby doesn't overfill it's stomach capacity by gulping too large a quantity too quickly. Also, triggering the reflex by hand expression, slight nipple twisting and/or massage 3-4 minutes prior to latching usually gives the surge time to subside so that many babies can deal with the subsequent trickling flow at their own pace. However, with an oversupply, subsequent MER's might again overwhelm the child. Using only one breast at a feeding, or offering the same breast for 2, or even 3 feedings, is often helpful. "Tames" the MER and less likely to result in temporary lactose overload. Also helpful is the use of "anti-gravity" positions, where the mom is leaned comfortably back, as in a recliner chair and/or the baby is propped up at a level above mom's nipple, and rolled over somewhat above the mom's chest. This position seems to "subtract" the force of gravity from that of the MER because milk is moved in the opposite direction of gravitational pull, making it much easier on the baby. This works well because the baby's posterior pharygeal air passage is then above the nipple. He also receives a slower, less powerful "uphill" flow of milk as if from a drinking fountain. This allows his tongue a chance to organize a bolus and transfer it around the epiglottis with a coordinated suck,swallow, breathe pattern. Positioning baby "downhill" from nipple puts his nasopharynx in a dependent position and permits gravity to have an additive effect to the MER. This results in his receiving the milk as if from under Niagra Falls, flooding straight downward toward the posterior pharynx, causing choking, gulping and bradycardia. A sidelying position, where gravitational forces play less of a role, also has less tendency to cause difficulty with suck, swallow, breathe coordination. Also, feeding smaller amounts (more frequently than scheduled 3 hour feeds) at least during the mom's waking hours, and keeping the baby as upright as possible all the time, are helpful. Diaper changes while the baby is semi-upright may be challenging, but this is one of the most important times, and it's also important to avoid extra intra-abdominal pressure from the knees being bent back on the abdomen during diaper changes. Carefully aligned body support in a car seat was also identified as a way to reduce reflux. I hope these ideas are helpful for "fixing the breastfeeding" and getting mother and baby much closer together soon. Jean ***************** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html