Breastfeeding premies is tricky. Babies all develop at different rates, and development is rarely always in a straight line going up. I tell parents, and nurses, and residents, that just as 12 months is considered the 'norm' for walking, but that some infants walk at 9 or 10 months and others not until 15 or 18 months and all are within normal range, so there is a 34 week 'norm' for adequate oral feeding. Yet not all babies are ready to feed at 34 weeks.Just like in walking, you have to look at the WHOLE child. There are as many variations on feeding readiness as there can be differences with premies. Basically, I like to put a baby to breast as soon as their medical status, temp and HR/RR is stable, whether they can take nutrition from the breast or not. It is good for the babies, and good for the moms ( increases prolactin levels and volume of pumped milk) I heard Paula Mier speak last year and she called this recreational breastfeeding- a term I like to use, and the Mom's and staff seem to understand and like it also. I also explain to mom (and staff) that to breastfeed well an infant must have adequate behavioral states( alert and awake long enough), strength and endurance, and organized sucking and swallowing skills. Most premies do not have all these skills at 32-34 weeks, but some do. Some babies don't click until 36 or more weeks. But I tell the parents that until these all come together, the baby must practice on the breast. I don't know if the analogy is totally correct, but I emphasize that for premies, breastfeeding is a skill as well as a reflexive motor response, and that skill must be rehearsed as much as possible, just like learning to swim or to play an instrument. Of course, if the infant looses weight, the medical staff immediately blames it on too much breastfeeding and restricts the moms to once a day- grrrrrr (when I do a lot of teeth gritting to remain calm). The only thing I would disagree with is about not to gavage past 32 weeks. I don't think you can put an arbitrary date on when a baby should not be gavaged. If a baby is 33 or 35 weeks but is unable to stay awake long enough or at all to breastfeed, why bottle feed? Just gavage the poor child. Uses less calories and avoids the artificial nipple. Of course there are many babies who don't get to breastfeed or whose mothers are rarely present, so they get bottles of ABM, unfortunately for them. My biggest beef and frustration is with moms who are present and giving a wide awake baby a bottle of expressed breastmilk- because they are under the misconception that it is "easier for him and I know how much he is getting." It is really hard to talk them into putting the baby to the breast. I am getting to them too late in their stay. Sorry to go on for so long, but this is a topic I feel very strongly about. Just a note on circumcision- For Jews, circumcision is prescribed in the bible. The Hebrew word for circucision is "brit" which means covenant. This refers to the agreement between God and the Jewish people, " And ye shall be circumcised in the flesh of your forskin, and that will serve as a sign of the covenant between Me and you" (Genesis 17:11). My own son's Brit Milah (circumcision ceremony) was much much more than a whacking off of body parts, but was a reaffirmation of our heritage and faith, a continuation from one generation to another of the passing of our beliefs to the next generation. I think most Jews will acknowledge this for their sons, also. Throughout the ages, circumcision was practiced only by Jews (do muslims circumcise their sons?) and men who were circumcised were identified as Jews and persecuted becuase of their faith, from the time of the ancient greeks through the second world war and the communists regime. But enough. Why non- Jews are circumcised I don't know, but I do know that it takes 10-15 times longer (and looks 10-15x more painful,) in a hospital than it does in a Jewish ceremony. I don't really think this is the proper forum for a discussion on circumcision, I just wanted to clarify this is terms of perspective. Debbie Rabin, OTR, CLC Los Angeles ( where Lactnet was the only thing I dragged myself out of bed for every day during six days of the flu and 102 temp this past week).