Denise. I'm glad baby is receiving more evaluation. I think it must be a bit tricky to eval. the extent of some heart defects. I've seen several babies of this type, and often their energy level is the pits -- way too low to expect baby to be able to sustain itself with normal bfg. They need lots of help, and in my opinion, the emphasis should be on helping baby gain enough weight to best tolerate surgery asap so the crisis can be resolved and parents and child get on with normal situation. I have worked with feeding tubes and bottles with such kids, and occasionally these aren't even efficient enough and child must be gavaged. Having seen one such case, I can warn you that if baby is not ever put to breast or given a pacifier to suck (to maintain happy mouth exper) they can get very aversive to any kind of oral feeds. I saw such a baby with repairable heart defect whose first symptoms were lethergy at breast and very swg. I referred to pedi, he sent to cardiol. and goal was to get baby up to a certain wt. for surgery. Baby couldn't get sufficient intake even from feeding tube or bottles.Gavages begun. Cardiol. nor hospt. staff mentioned letting baby have pacifier or 'dry sucking' at breast. In fact, this was discouraged as it might use up calories. I disagreed, but was over-ruled. This is not an "I told you so" that I gleefully insert, because results were a nightmare. Baby wound up being gavaged for a year and it took a PT a lot of therapy to get anything in the child's mouth. Baby freaked when anyone came near her, and parents had fragile child syndrome: feared absolutely that stress would harm her and backed off on moving her away from the very thing that (tho familiar) was givng her oral aversion (ie gavages) for fear she'd starve from refusing to eat. Very complicated. The good news is that mother pumped for 12 months, and no matter how milk was delivered, it was breast milk. Child recovered well physically and has been healthy. she is 2.5 now, and when I saw her the other day seemed small but normal. Parents shared story of pumping with L-----a in all sorts of odd places: airports etc. Dad holding up a coat to give as much privacy as possible. It was a heroic effort that they feel good about now, but mom gave cardio. and hospt. nicu staff a good talking to about how some of their difficulties could have been avoided by allowing baby to get to actually suck in her early days. You know, I think that getting baby to breast or to suck may be one of those developmental things like Lawrence ref. when she discusses that babes need to begin to eat during a certain time period or they may miss a develp. window and have more feeding problems with solids when introduced later. Now some babies aren't ready and learn to eat fine later, but putting things in their mouths (which they all do as soon as they can) prob. serves the same purpose. This is why I think it is so impt. to get babies to breast rather than think that cup or finger feeding is anything more than just a way to keep babies alive. Barbara Wilson-Clay, BSE, IBCLC Austin, Tx priv. pract.