Tips on encouraging root, latch and suck in a nipple confused preemie please

[InmaculadaConcepcion]

Lots of well-intentioned cock-ups by the hospital meant my 5lb DD (born at 36 weeks) missed early skin-on-skin, was separated from me for ten hours (despite no health problems requiring medical intervention), was too dopey to initiate bf then was given bottles. I was given a nipple guard and she does suck from that.

However, I am now trying to wean her from both guard and bottle to get her on the breast. The prem team say she needs feeding every 2.5 hours, including a 20ml supplement to get her weight up (unlimited time on the breast as well) until she reaches 3kg (currently 2.35kg).

Sometimes she will suck direct from my breast, but it's a poor latch - nipple only.

I'm doing lots of skin-on-skin (esp overnight) and always offering her the breast before any supplement (mostly takes the form of my expressed milk). I'm considering getting a lactation aid - anyone used one? Are they helpful in this situation?

DD can suck all right, but she doesn't do a wide-mouth root - any techniques to help encourage this? She is now 12 days old.

I'm looking at the kellymom, LLLI and nbci websites and trying out all their suggestions where possible.

Anyone who has experience of solving nipple confusion - I would hugely welcome your thoughts!

Ok, you need to give a suplement for now. I would be trying to not use a bottle at all, as bottles encourage nipple-only latch.

Have you been taught how to cup feed? Or tube-feeding, either from your nipple or your finger? Cup feeding is less of a faff (and much better than bottles), but tube-feeding is better prep for breastfeeding.

Are there any other health issues?

Have you been seen by a BF specialist, to sort out the latch? If she latches just on the nipple, I would take her off, I'm afraid - letting her do that encourages bad habits and will probably hurt you. (both in terms of immediate pain, and damage to your nipples)

If you're happy to say what town you're in, I can try to dig up local groups for you. I know getting out of the house may well be tricky at this point, but proper BF support can make a real difference at this point.

Thanks for the swift reply, NQC!

No health issues, as far as I know. She hasn't been checked for tongue tie, but I don't think she has it.

Yes, I was thinking about cup feeding and the tube, I will go ahead with these pronto.

I live in Madrid and my Spanish is not great, but I am on the verge of contacting local LLLI people in the hope that someone may have some English, or DH can help (his Spanish is a bit better than mine).

Can this BE solved, do you think? It's all a bit knackering at the moment with the feeding regime and all the expressing, plus the disheartening attempts at "naked" bf - but if I think we've got a chance of sorting it, I'm willing to keep at it.

Thanks again, I really appreciate you taking the time to post. Being ex-pat, it's easy to feel alone with this problem.

Yes, I think it can be solved.

I don't know what to say about LLLI, they're certainly worth trying. I googled and found [url=www.mumabroad.com/living-in-madrid-9160/pregnancy-in-madrid-9162/gynaecologists-and-doul as-in-madrid-9175/]this[/url] page about postnatal care. I assume these are all people you would pay. The first, third, and last people all look relevant.

The nipple shields are a pain, but if they mean your DD feeds from you, then that's worthwhile. The only downsides to shields are a) they're a faff, and b) in some mothers, they reduce milk production.

Unfortunately, in the current situation, your milk production is likely to be low, and you need to do whatever you can to build it up. (I'm assuming here that after your baby has fed, for a long time, your breasts feel empty, and you're not getting any lumps?) Do you have a pump? Or do you know how to hand express? It might not be a bad idea to express after feeds, for a few minutes, just to boost things a bit. You can include whatever you get in her 20ml supplements.

You're giving 20ml supplements, how often? And how is her weight gain?

Is she producing yellow or green poo now? And if so, how often? (It needs to be as big as a 50p piece to 'count')

I think tube feeding would really help. You can do it on your finger or on your nipple. If you do it on your finger, it needs to be on the nailless-side. It's best to get this demonstrated to you in person, somehow, though ...

Oh, pants, mangled that link, it's this.

Also, should have added, please do as much skin to skin as you can do now - you're probably already doing that, though.

I have no idea about feeding premature babies, but in a video I watched on youtube the other day about different latches, the breastfeeding expert used his finger to gently pull the newborn baby's chin down and improve the latch. Link Click more info at the side, there's lots of advice and links there. hth

That's a Jack Newman video - he's great.

Hi Inmaculada,

I had the same problems with my DD. She was born at 36 weeks (her weight just above 2kg )with an emergency c-section and I was in intensive care afterward so no skin-to-skin and when i saw her the first time she was sucking at a bottle of formula. As you i was instructed to feed her every 2 hours, including a 20ml supplement to get her weight up

To be honest the first thing i did was stopping giving her formula supplement, replacing it with expressed breast milk from the bottle, and never ending breastfeeding sessions in the evening (I used to fed her lying down from 4 to 9 pm) and unlimited access at the breast during the day. at the beginning it was more comfort sucking (and nipple sucking!!!) but i was adjusting her position until she was properly latched and she was basically just spending time asleep at the breast, but when she turned 3.5 kg she started refusing the bottle and now she is a breast-maniac!!!

I'm an expat too with no family around to help and I know how hard it is to be alone and far from home and you will need a lot of patience and will power, but you are already doing a wonderful job.

Hi all

You guys are wonderful, thanks!

To answer your questions NQC, she has the supplement at every feed - often 30ml. Pooey nappies around six or seven times in 24 hours and wet at other times. A strong mustard colour.

I've got an electric pump and express as often as poss during the day after feeds - not at night though, I have to try and get some sleep! Her supplement usually comes from these sessions.

Her weight gain seems to be pretty steady, so far.

Just tried the cup-feeding - I think some of it went down!!

Thanks for the links, fantastic - I'll certainly get onto those.

VERY heartening to hear your story, Andromaca - it's giving me the strength to carry on!!

Ok, great, if her supplement is mostly formula, then most of her weight gain is from you, which is great news for your supply. If you can get her to the point where all of her supplement is from you, then you can stop the formula altogether, and move more and more to her getting milk directly from you.

Re: the latch, are your nipples flattish? Does pumping a little bit before a feed change their shape? Some mums find this helps the baby to get a better latch.

Ah, thanks for that, justabout, good to know.

Her suck seems fine, she has no problem finger feeding, loads of strength to it. Her rooting is not good though and she can't seem to apply her suck to my nipples.

I do have quite small nipples and breasts, don't know if that's a contributing factor - mind you, so is her mouth! Yes, I've tried the post pump trick and will continue to do so. I'm trying everything!!

Rebirthing, anyone? Any success stories there?!!

Brief update -

DD is now getting 100 per cent EBM supplement (thanks, Medela Swing!) with 1 oz or more expressed from each breast per session - seems to be going up too, which is good news.

The lactation aid appears to be doing the trick - after a frustrating time getting her to use it properly (she would keep trying to get the milk direct from the tube, what a cheat!!) but now, she seems to be getting the hang of it and continues suckling from the breast once the the supplement is finished. She's also getting better at latching on in between times - still not a great latch, but definitely improving.

I'm giving her the supplement from the bottle for the three overnight feeds, but she's feeding from the breast at these times as well. Once she's really motoring with the lactation aid, I'll use that in the dark hours too, but at the moment it just takes far too long.

I'll keep at it and see where we are when she reaches term in about ten days time - if we're still struggling, I may well see one of the BF experts in your link, NQC.

Thanks again for all the advice and support, everyone!

Thought I'd give another update as I had so much good advice and encouragement from people on this forum.

DD is now 13 weeks and has finally got the hang of breastfeeding. She's not consistently a brilliant feeder, but her latch no longer cracks my nipples and she is able to trigger at least one strong let-down and often 1-2 more (plus, probably, let-downs I don't feel) per feed. She doesn't generally feed for a terribly long time (5-10 mins), but she is alert, produces a goodly amount of pooey nappies and is putting on weight nicely. In fact, the pediatrician expressed surprise that she was still EBF (well, I have given her a couple of mls of formula when I've worried she hasn't latched properly and had a decent feed...but it doesn't add up to much at all, she's mostly not interested) because of how well she's doing.

I'd say it's now been a fortnight since I felt DD was finally getting the hang of it, latch and all - so at about 11 weeks.

Ironically, DD's now virtually lost the ability to drink from a bottle as she tries to use her tongue to extract the milk in the same way that she's learned to do from my breasts - but I'm not complaining, at least she doesn't tend to suck on my nipples anymore.

Anyway, I thought I'd post this as a way of saying thank you to those of you who supported me when I was almost at my wits' end and also to offer hope to anyone else in the same situation. It took patience and time and a certain amount of frustration, but we got there in the end.