Cup Feeding Strikes Again! - page 3

So I had this lovely little guy, about 3700 grams, term, some meconium staining at birth, otherwise completely boring pregnancy and vaginal delivery. He had some low blood sugars (which we call... Read More

  1. by   eandgsma
    Hi all...

    I'm not a NICU nurse or a nurse at all. I'm a student nurse with a background in lactation. Anyway, after reading the posts above I noticed one suggestion not mentioned. What about an SNS? That would supply the babe with formula to control the blood sugars but also keep the babe at breast to get that great colostrum AND keep up supply.

    Just a suggestion. I'm sure its already been thought of but I was wondering why or why not use a SNS?

    - N
  2. by   prmenrs
    It IS a good idea to use a Supplemental Nursing System (SNS). It ought to be used more often. They're not a total snap to use, however, and I've met more than one rather precocious infant who figured out where most of the milk was coming from and started sucking on that tiny little tube instead of mom. rotten little kids (JK!!)
  3. by   LYRICS84
    I personally don't use an SNS very often for the reason noted above and also, they can be difficult to wean from. Baby MUST be able to suck well. Also, from the point of cost containment (especially since sometimes it is only needed once or twice) SNS costs about $30 per unit as opposed to $2 for a cup. All you guys having trouble with the cup - come and see me I will show you the proper technique and you will no longer dread it :Crash: :Crash:
  4. by   prmenrs
    Our hospital is too cheap to get a real SNS--we use a syringe and #5 feeding tube.

    We also use a small plastic pipette to squeeze formula onto mom's nipple to keep the baby latched. Works w/some kids, and dad can be taught to do it.

    Last time I asked for PT for my back, I blamed it on breastfeeding!
    Last edit by prmenrs on Jan 12, '07
  5. by   LYRICS84
    Yeah, I always put the bed up in high position before I help anyone - except the few stubborn ones that insist on sitting in a chair. Working as a RN in L&D for many years sure gave me insight before getting my IBCLC. My best friend is an old NICU nurse who rolled her eyes when I said I was pursuing lactation. Yes, there are some rather aggressive characters out there. I am sooo not the obsessive type, and I even recommend formula on occassion sshhhhhhhhhhhhhhhhhhhhhh
  6. by   LilPeanut
    My son had nipple confusion. I think a lot of people don't realize what the signs of it are. He was a 34 weeker that didn't start nippling until he was 36+ weeks because he was a WWB. He had a few great nursing sessions, then got tired, they gave him a bottle, then he would try the breast, either cry or fall asleep because to him, the milk wasn't coming out fast enough.

    With finger feeding, you can press on the plunger, but just not quickly. Part of it is to help train them of how to suck correctly, so when you feel the right movement of the tongue, they get a reward of milk.

    It took a little over 24 hours of finger feeding at home to get my son to nurse again. I think though a lot of people see the baby falling asleep or crying after a couple unsuccessful sucks and they don't say "oh that's nipple confusion", they assume it's something else (don't get me wrong, it can be other things, but it can also very often be from nipple confusion)
  7. by   LYRICS84
    Infants born before 37 weeks often have issues with coordinating suck, swallow, and breathe at the breast. Many tire out too quickly to obtain enough at the breast to sustain them. I've done alot of research with nipple shields and (in my experience) have found that they work great with these little guys. The pressure actually keeps the milk in the shield, so when they stop to swallow, they can readily resume sucking without having to relatch over and over. This prevents them from working too hard and tiring out too quickly.

    I agree "nipple preference" or "nipple confusion" does exsist. Sure not every baby will have difficulty with both feeding methods, but how do you know before giving a bottle how your baby will react? Usually after 3-4 weeks babies do well with both, but not right after birth.
  8. by   LilPeanut
    But the point is the minorly ill baby (low blood sugar that will restabilize) who has problems at birth with confusion will often not get the chance to eventually learn because the moms will become confused, tired, sore, think the baby hates them or nursing and will give up before that 4 week mark when they might be ready again.

    To some extent, babies are designed to withstand dehydration and low blood sugar as newborns because that's their normal state - colostrum doesn't give much in the way of fluids and milk takes a few days to come in. For some reason, this is how the human body was designed and in many cases, it is ok like that.

    Again, this is not saying that every baby is ok with low blood sugar or low fluid amounts, but just that in certain circumstances, it might be ok.
  9. by   LYRICS84
    I agree with you 100%. That is why it is in the best interest of both baby and mom if no artificial nipples are introduced before breastfeeding is well established. Unfortunately, there are circumstances that dictate intervention, hence the many alternative feeding devices that are now available (ie- the cup).

    I also have a question to all of you who have difficulty with the cup. Are you using a regular hard plastic medicine type cup? I use a "Foley" cup and have had much better success with this particular manufacturer. The cup is soft and flexible, and has a lip on it to pool a small amount of the milk so baby doesn't accidently get a large gulp.
  10. by   Sweden
    In my hospital we are not allowed to use bottle feeding (BabyFriendly Hospital). That includes babies in the neonatal unit.

    Cupfeeding/breastfeeding and gavage are the only ones allowed (unless mum request bottlefeedings ofcourse). Cupfeedings are allowed from 29 weeks in our unit!

    No more than 2 ways of feeding methods per session/feeding. Cupfeeding is seen as a good way for the baby to train its ability to feed correctly (towards breastfeeding). When the baby uses cupfeeding the same facial muscles are used as in breastfeeding, not so with bottlefeeding.

    90% of the babies born after 26 week in our unit are on full breastfeeding when they go home!

    Last edit by Sweden on Jan 15, '07
  11. by   tntrn
    Every time I hear about cup feeding, I think those babies should just be given a spoon and fork and be done with it! LOL, a little. Ever have a Dad want to be hooked up to the SNS? That did it for me.
  12. by   YA4US4
    I worked in NICU for many years, but not for a few years now, so not quite up to date. However, would like to mention a few points-
    A newborn does not require a lot of fluids for the first 2 days, as their urine output is low-natural way to cope with the low fluid intake of colostrum.
    Colostrum is high in calories to maintain blood sugar unless there is an added reason for excessive or chronic low blood sugar, eg. prolonged and complicated deliveries or if the mother is diabetic.
    Colostrum is the best milk for the infants gut and is easily digested(using another mothers milk is not practiced anymore, due to risk of spreading diseases like HIV).
    Preterm babies should be be encouraged to breast feed when well and have good sucking reflexes-we used to start them breastfeeding slowly and for short periods as not to tire them and therefore cause them to loose weight-they would combine nasogastric feeding with breastfeeding, as they would suck away on the breast and still have a slow feed through the tube, and increase breastfeeding times as they got stronger. The nasogastric feed would hopefully be the mothers expressed milk.
    Full term babies that were apparently nipple confused if given supplimented feeds through bottles, in my opinion were over fed with formula, if in the first few days or were just exaused post delivery, or there was a latching problem-difficult nipples, or the baby had a slow/weak sucking reflex.
    Jaundiced would appear in some babies mostly due to excssive break down of red blood cells in the body, and seldom due to dehydration.
    If the mother is unable to feed her baby by breast to begin with, then she could try expressing colostrum onto a spoon, and spoon feed the baby. Cup feeding should only be used in chronic feeding problems, and therefore not encouraged.
    An exausted mother may need a rest now and then, and cup feeding can help then-or the odd bottle feed. If the baby is healthy and has a good sucking reflex, the odd bottle feed should not cause feeding problems, as the healthy baby would naturally know the breast milk is better (sounds crazy but nature is wonderful, and like other living and reproducing creatures, the human being is driven by natural forces), plus, the healthy baby i'm sure would not prefer a milton soaked, hard teat over the soft, pliable, warm nipple which is attatched to their favorite person, who has that gentle touch and voice they have been used to hearing for the last few months.
    It helps if mothers maintains a good diet, rests well inbetween regular breast feeds, and keeps the baby properly latched at the breast at each feed-this is encouraged if enough help is available to new mums.
  13. by   lovemyjob
    Dehydration may not be a cause of hyperbili, but it can make it worse because the concentration is higher and they are not fed enough volume to stimulate the gut to excrete the bili in the stool. when the bili rises and the infant becomes more and more lethargic he is less likely to have a successful feeding at the breast to help with the dehydration or gut stimulation and what bili the gut is trying to excrete is reabsorbed, all compunding the problem.

    Sweden, do you thicken feeds for your preemies with poor suck/swallow and use the cup method? I would imagine a kid who was having problems aspirating would have a more difficult time with the cup because it would flow faster.