Hope to Transition from breast to bottle with oral aversion, tongue tie?

[Ratchet]

my DD is a NICU grad, born at 27 weeks.  She's been home for a month now.  Because of being intubated, oral-gastric tube, etc she likely has some oral aversion.  She did some breastfeeding in the NICU but we focused mostly on bottlefeeding-- she had been such a poor feeder (slow, uninterested, fighting against it, minimal rooting reflex) we needed to do whatever we could to get her eating by mouth.  She actually came home with a naso-gastric tube for feedings but she stopped needing that pretty quickly.  She is just now doing well enough with feeding that I think she is ready to learn how to breastfeed.  she is tongue-tied, I was told it is not enough to be an issue- she is capable of sticking her tongue out beyond her lower lip, but with the bottle she doesn't really need to and I noticed she doesn't keep it out past her lower gumwhen I have her suck on my finger.

She will latch, if first i pump so she doesn't have to wait for let-down and so my nipples are more prominent.  With a nipple shield she can't get much suction going and it doesn't fit my breast well so I'm not using that.  The SNS/ Lactaid seems to also ruin her suction although I've only tried it along with the nipple shield.  She will suck for 30sec or so then get unhappy and unlatch.  I imagine she is not getting as much flow as with the bottle.  I am hesitent to use the SNS/ Lactaid directly into her mouth because it is so close to the oral-gastric tube and I worry about worsening oral aversion (same thought for clipping a tongue tie, too).  But maybe i'm just being whiny b/c it's more gear and more hassle. 

I usually do 1 or 2 breastfeeding attempts per day, for approx 10min or until she's really pissed, then give her the bottle.  I have been exclusively pumping now for 4 months so I can keep doing this as long as I need to, but would rather breastfeed if I could of course.  I work part time now and will go to full time in January, and she is home with her dad.

Any one want to share a similar experience (regardless of the outcome) or any suggestions?  I am actually a LC myself but it is only a small part of my career, and it's hard to have a good perspective on you own situation ;)

thanks!

[Alice27]

I know what you mean about being hard to have perspective on your own situation - especially when you have a new baby, sleep deprivation and all those stresses of hospitalised baby etc.

My daughter was born with a cleft lip and palate (if you do a search on my posts you can read the whole story).She also has some degree of oral aversion (fussy with food etc.). She was never intubated but did refuse the breast at the beginning and post surgery.

I used the self latch-on technique to get her to latch on, and after a few sesions she didn't refuse the breast anymore. Post surgery she was on a kind of nursing strike and I used a nipple shield with an SNS tube threaded underneath (so she didn't actually have any contact with the tube). That is a good wat to transition a bottle fed baby to the breast because you become a kind of human bottle:) But sounds like that isn't the right solution for you.

Your daughter isn't actually refusing the breast though, is she. You just need to get more milk into her?

Have you tried-

Breast compression? (Jack Newman's website has a video)

Alternate bottle and breast?

Latch baby on more frequently (for instance, while the bottle is warming, but just for a few minutes each time?

Latch on after feedings and between just for comfort (this will help increase your supply)?

Wear your baby between feeds to help increase supply?

Drip milk onto your breast while your baby is feeding so that she will be encouraged to swallow and suck more?

I have seen videos of cleft affected babies (who can't suck efficiently enough to get much milk) alternating breast and bottle. You feed them a little of the bottle and it seems quite effective. You could even try a Medela special needs bottle (or a bottle with a soft nipple and large hole) because a baby with suction (as mine was after her palate operation) will get the milk really fast without satisfying her need to suck. You could also use same bottle to squirt/drip milk onto breast while she is nursing at breast.

BTW, with oral aversion you may want to line up an occupational therapist when you start introducing solids. My daughter is five and still very fussy about what she will touch and ingest. Still nursing though:P

Alice

[Megan73]

Sorry to be terse - NAK
I would try the Lact-Aid without the shield first.
If that fails, you could try the "finish at the breast" method of supplementing. Give an ounce or two by bottle then - when she's not angry and starving - offer the breast.
I assume you're doing suck training to get that tongue out?