Help! My baby doesnt suck......

[Jazmyn]

My first baby, Jack, was born on 20th July, 3 weeks premature. We are very keen to breast feed but when he was born he had no sucking reflex (apparently this sometimes doesnt kick in until later in prems?). I've been expressing since he was born and we spoon fed him for the first 3 days and since then have been finger feeding him with a syringe to try and get him sucking.... VERY slow and tedious but we're persistent!

Up until now it's been more important to get the food into him rather than concentrating on the manner in which it gets there as he's been loosing weight. At one point we were thinking he might have to go into hospital he'd lost so much. He's now gaining weight and feeding better although he still falls asleep mid feed and refuses to take any more or wake up again despite our most persistent pestering! This problem is exaggerated when I spend too long trying to get him to breast feed as he gets tired out very fast.

We've tried using the syringe whilst he's on the breast and also using a tube down to the nipple but he wont suck it in. When he's feeding on the syringe he will suck a few times in the beginning when he's really hungry but after that lets us do the work and just lays there and swallows!

We've had advice from breast feeding councellors, La Leche leaders, midwives but so far nothing has really done the trick. i was hoping there might be others out there who had the same problem for this long who went on to successfully breast feed who can reassure me and tell me how you managed it?!

Help!

Am watching this with interest. My dd is 18 weeks old and was induced at 39 weeks and was born using a ventouse and forceps. Possibly because of this she has a very weak suck. BF was absolutely continuous and now she is on the bottle she feeds 2-3 hourly and each feed lasts two hours or so. Yay!
She was on teats for three months old at 6 weeks and I am going to try teats for 6 months plus this weekend with her.
So no advice I'm afraid - other than it won't be much better with the bottle in terms of time consumed so keep going with the bf!

Can't really help, but wanted to offer support and say my DD who was born at term was also a sleepy baby and always feel asleep on the breast. I generally fed her in a just a nappy (and I'd take my top off too) and changed her nappy when I thought she was looking like she'd drop off. One thing to note though with BFing is that unlike bottle feeding the flow is not consistent and most of the milk volume is delivered at the start of the feed.

Sounds like you are making progress though and if you stick with it he'll gradually be less sleepy. Hope someone comes along with more experieice of this soon.

Hi Jazmyn,

I am sorry to hear you are having trouble with feeding your little, but please be assured there are lots of things you can do.

There are many reasons why babies won't suck and I will go through a few for you which you can then discuss further with a breastfeeding person/professional.

1. baby needs to learn to suck in order to transfer milk. To do this, he needs pressure on his tongue which means that he needs a good mouthful of breast tissue. Without this, his sucking/milking reflex won't kick in. The use of a nipple shield is a temporary solution, but we still need to look for the root of the problem and resolve this.

1. oral anatomy

Does your baby have a tongue tie - a little membrane underneath his tongue which pins his tongue to the floor of his mouth. Very common with early babies and also run in families. If his tongue movement is restricted, he won't be able to cup or hold the breast firmly enough to begin sucking. You will need to have this assessed properly by somebody who knows about tongue tie and breastfeeding.

1. delivery or birth

When a baby is born, his head will go through natural compression. Sometimes if this compression is stong, the head is noticeably compressed and this suppressed nerve function, particularly the nerves which look after the mouth and tongue movement. (hyperglossal, glossopharyngeal and vagus nerves) A cranial osteopath can ensure that your baby is in complete alignment and thus better able to transfer milk and breastfeed.

Also have a look at the Medela Calma bottle. it works on the same principle as breastfeeding and may help your baby to nurse and will certainly help you increase the amount of milk baby takes in.

Just one further point, when babies are small/young/new it is is often better to give them some milk before you try them on the breast. This will give them energy and take the edge off their hunger, which will help them focus and try a little harder at the breast.

I can't see how much your baby weighs but to calculate how much your baby needs at eac feed:
take his weight in kg x 180ml = how much your baby needs in a day.
Now divide that by the number of feeds he has in a day to find how much he needs at each feed.

e.g. if 4 kg x 180ml = 720ml a day
Feeds 8 times = 720ml/8 = 90ml at each feed.

Give him half a full feed (45ml in this case) before you even try him on the breast. Only try him on the breast for 5 minutes. If he is still fractious, give him more milk and then try him again. Offer rest of milk and finish the feed.

The whole feed should not take longer than roughly 45mins, or he will become over tired and difficult to feed.

I do aplolgize if this seems a little technical, but hopefully it will give you a few options to explore further and result in a happy mum and baby.

MissGG - fab post! thanks very much for the suggestions!! Jack was 3.1kg when he was born but is now just under 3kg. We've been advised to feed him between 60 to 80 ml depending on how much he will take so that fits in nicely with your calculation. He normally starts to fall asleep at the 30 ml mark which is when you suggest that I try him at the breast... I will try after 20 ml as at that point he's normally still alert enough to concentrate. At the moment I've been trying it before a feed so it will be interesting to see a difference!

We're planning on trying the nipple shield as a "go between" between finger feeding and breast feeding. I'll get DH to nip out for one this afternoon.

With regards to the tongue tie issue it's not something I've heard anyone mention here but then I live in Holland and it may be called something else, I will ask about it when I next see our health visitor.

Also no one has mentioned the head compression issue although when he was born he "got stuck" because his head was in the wrong position so he did indeed come out with a slightly elongated head (this was the only reason we ended up in hospital, otherwise it would have been a very fast home birth!). I have no idea if they will know what I'm on about when I ask about this but I will indeed try!

The bottle sounds like a good back up plan if all else fails in the next week or so, my DH has 2 more weeks off work but we want to have him feeding better before then. We will keep trying, we're both very stubborn and persistent people!

I look forward to any more suggestions!

Congrats on your little one, Jazmyn.

It's true that preemies often still need to acquire a sucking reflex as it's something that develops late in the pregnancy.

I think a tongue tie is a te korte tongriem, does that sound right?

Anyway, my baby was 6 weeks early and spent two weeks learning to tolerate breast milk through a feeding tube. By that time she'd developed signs of a strong suck but it still took a week and a half before she was fully over on "manual" feeds. Like you, I also spent a lot of time pestering her to wake up.

Something else I found that helped was getting her skin to skin, which is known to improve milk supply. Have you heard of kangaroo care / kangaroemethode?

Of course, the other thing you need is time and patience but I'm sure it'll happen for you eventually as you sound so determined and also like you have a very supportive partner.

Feel free to private message me if you want to chat. Good luck!

A quick update....

I say "tentatively" that we've been having some success!! My wonderful little boy has now had 3 breast feeds of +5 mins continuous over the past 2 days. (I have NO idea how long is normal for a full feed at this stage) It takes a LOT of perseverence as he gets frustrated and angry for the first 5 to 10 mins trying but eventually relents and settles into a nice sucking pattern, eventually falling asleep. As it felt so different to the breast pump I was wondering if he was ACTUALLY getting any food until after about 10 mins he stopped and did the biggest burp EVER! Even for me, it was MOST satisfying!!!

So, we're continuing to try him every feed, he doesnt always take to it but it is definately improving and we know he CAN so there's no serious issues like the tongue tie or compressed head. I think it's just a matter of slowly re-adjusting him from the syringe to the breast.

Steep - we've been doing the kangaroo thing as well from the start although tbh at this point it's really just for the comfort of it now as my milk supply is definately NOT in need of any assistance, I generally have enough to feed a small "baby army" and already have several litres stashed away in the freezer.... at 11 days after the birth I produce around 200ml every 3 to 4 hours.... I was even asking around to see if anywhere took donations but apparently the local prem baby ward doesnt have a pasturising system set up yet, shame!

I'm such a happy bunny, it's the best feeling in the world when it all comes together and you hear the little glugging noises!!

Awww, lovely! Well worth all the hard work in the end :)