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Thread: Preemie in NICU - nipple confusion?

  1. #1
    Join Date
    Jan 2007
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    Unhappy Preemie in NICU - nipple confusion?

    Hi! I'm so glad I found this site. It seems like people have a lot of nursing experience and wisdom to share...and oh do I need it!

    I have a 3 week-old little boy, born at 33 weeks, and even though he has no medical issues, he'll be in the NICU until 37 weeks (he needs to show steady growth and keep body temp. stable). I have started nursing him about a week 1/2 ago (he was originally fed through an NG tube) but only for about 4 feedings a day since the doctors and nurses are insisting on feeding him with a bottle (my breastmilk) most of the time in order to "measure" his intake (this drives me nuts!!).

    I have been working with a lactation consultant since day 1, pumping every 3 hours and getting assistance with helping him latch on...etc. Baby has been doing well latching on, but tends to fall asleep after 5-10 min. of nursing. I have read and heard that babies need to suck differently to get milk from the breast in comparison to bottles, so I'm getting worried he's just becoming "lazy" when I nurse him, since I hear he has to give a little more effort at the breast. The lactation consultant suggested today that I use a shield to ease the transition between breast and bottle (she also said that my nipples were a little on the "flat" side...lovely, I know ), and baby did really good with it the 3 times I nursed him today.

    But now I'm wondering if the shield is such a good idea. What do you think? Is it ok for him to get used to the shield or would it be best just to keep trying without it until he stays awake the whole time? Will I ever be able to breastfeed without the shield? My baby is moving out of the NICU tomorrow and will be transfered to the pediatrics floor, so I will most likely be able to share a room with him and have a little bit more freedom as far as when and how often I nurse him (he's now on a strict 3 hours feeding schedule).

    What do you recommend I do. Keep up with the shield since it works well, or nurse without it to get baby used to it? Do you think I'll be able to breastfeed 100 % of the time when I take him home? OR will I always have to alternate with bottles?

    This whole ordeal has been so hard on me, I always thought I would breastfeed from day one, but instead, it's a constant battle to even get the nurses to let me breastfeed, and when I do, it's with 20 people in the room working with other babies, bright lights and machines beeping, a lactation consultant starring at me....etc.
    I can't wait until I get my little one at home! Please tell me my efforts are going to be worth it in the end!!!!

    Thanks!

  2. #2
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    Oct 2006
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    Smile Re: Preemie in NICU - nipple confusion?

    I'm a first time mom so take my comments with a grain of salt b/c I do not know as much as the other moms on these boards. I'm sure more experienced moms will have more information but I wanted to say Congrats on your LO - despite being early it sounds like your little boy is doing well. I may be the odd person out here (sorry to those I offend) but I was told so many horrible stories about nipple confusion before I had my LO that I refused to use a bottle when my LO was too weak and sleepy to nurse.

    My LO was born at 6.4lbs (also jaundiced) and was down to 5.2lbs at 2 weeks of age. (Yes - we felt very bad for starving her by accident!) I was producing milk but she refused to nurse, slept too much and we were struggling with cup feeding and oral syringe feeding to avoid the bottle issues (b/c of the fear of nipple confusion). I tried to nurse every time we fed and after I failed (every time - this was hard) we would feed with the cup/oral syringe. We thought we were getting enough milk into her with the cup and oral syringe but at the 2 week check-up we were shocked to see just how small she still was. Our Pedi-doc insisted and we started using formula and breast milk in a bottle and she gained 1 pound in the next week. After that, she started to nurse! He latch was pretty bad but the Bottle Helped her learn to Nurse! It did NOT cause confusion - rather, it helped her learn and become strong enough to nurse.

    It was a rough and horrible road at the time and I thought I would not make it but I am a very stubborn person which proved to be useful. I am so happy I stuck it out. This message board and my local LLL leader helped and she is now nursing all the time and only takes bottles at daycare.

    I would say that since your little boy is already nursing and taking a bottle that he will continue to nurse! Good luck and remember you are doing a great job!
    Samantha: born 3 1/2 weeks early on Sept 2006 6lbs 4 oz 18 inches long with situs inversus totalis. Now a strong healthy little girl that wants to be a NICU doctor, loves her little sister and breastfeeds her dolls!
    Milk donated with while nursing first LO: 2,200 oz
    Alexandra: born 3 weeks early on July 2010 7lbs 8 oz 19.5 inches long.
    Milk donated with while nursing first LO: 1,200


    For information on becoming a Breastmilk Donor http://hmbana.org/index/donatemilk

  3. #3
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    Dec 2006
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    Default Re: Preemie in NICU - nipple confusion?

    I read not to use them when you nurse because babies get dependent on them b ut I too am a first time mom and you can not already believe what you read.

    I also think that the falling asleep when they eat is normal for new borns and since your child was early think of him as 5-7 younger then he is (Im sure you have heard that already a million times) my daughter did that for about 2-3 weeks after birth and she was 40 weeks when I had her. Her father did that too just ate enough to fall asleep.

    As for us my daughter will be 4 months on the 21st and is LAZY she will only nurse at night and in the early morning but thats not always the case she would rather have the bottle since she doesnt have to do much. This has been going on for about a month and it kills me but I got a hospital grade pump and am not giving up

  4. #4
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    Default Re: Preemie in NICU - nipple confusion?

    I did not have a preemie but I know a woman who has had three. All of them received bottles while in the hospital and transitioned to the breast just fine. It does take some perseverance on your part. She is one of the people who believes nipple confusion does not exist, along with me and my lactation consultant. My son received bottles early on, and a paci starting at 3 weeks and he's a very good nurses, we almost never use bottles anymore.

    I used a nipple shield with my son because of engorgement and at first was upset the LC gave it to me and felt like he's never be able to nurse without it. At about four weeks old I was able to wean him off fairly easily. Since the ultimate goal is for the baby to get your milk, I say use the nipple shield and don't stress about it, you can wean off it when that time is right. The biggest reason I didn't like the nipple shield is that it made nursing in public more challenging. I say do whatever you have to now to make it through the early weeks and you can eventually have the breastfeeding relationship you want!

    Anne- Mom to two active boys: Henry 10/06 and Jamie 4/09


    Looking for an LLL leader in your area? click:
    http://www.llli.org/webindex.html

    confused about abbreviations? check this out:
    http://forums.llli.org/showthread.php?t=807

  5. #5
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    Default Re: Preemie in NICU - nipple confusion?

    sounds like your quicky going to have that baby home, then you can do what you want. I would try and skip the sheild. It's just another thing to come between you and baby.and thats not a good thing!
    and the reason the lc wants you to use it is kind of silly.
    Your right breastfeeding is diffent then bottle feeding, plain and simple.
    the bottle can help some babies learn to nurse.
    good luck
    don't be afraid to call your local leader!

  6. #6
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    Default Re: Preemie in NICU - nipple confusion?

    Quote Originally Posted by Sadietoo View Post
    Hi! I'm so glad I found this site. It seems like people have a lot of nursing experience and wisdom to share...and oh do I need it!
    Welcome!

    Here is a resource you might find helpful:
    http://www.lalecheleague.org/NB/NBpremature.html

    Quote Originally Posted by Sadietoo View Post
    I have a 3 week-old little boy, born at 33 weeks, and even though he has no medical issues, he'll be in the NICU until 37 weeks (he needs to show steady growth and keep body temp. stable). I have started nursing him about a week 1/2 ago (he was originally fed through an NG tube) but only for about 4 feedings a day since the doctors and nurses are insisting on feeding him with a bottle (my breastmilk) most of the time in order to "measure" his intake (this drives me nuts!!).
    That would be irritating. I'm wondering if it would be feasible to weigh him before and after feeds instead? Could you talk to your IBCLC about this option?

    Quote Originally Posted by Sadietoo View Post
    I have been working with a lactation consultant since day 1, pumping every 3 hours and getting assistance with helping him latch on...etc. Baby has been doing well latching on, but tends to fall asleep after 5-10 min. of nursing.
    When you notice he is stopping actively sucking, try compressing the breast. This will make more milk come down and his sucking reflex will kick back in. In other words, it will keep him actively sucking. Here's some more info:
    http://www.kellymom.com/newman/15bre...mpression.html
    To see videos of the technique, go here:
    http://www.thebirthden.com/Newman.html

    Quote Originally Posted by Sadietoo View Post
    I have read and heard that babies need to suck differently to get milk from the breast in comparison to bottles, so I'm getting worried he's just becoming "lazy" when I nurse him, since I hear he has to give a little more effort at the breast.
    Your IBCLC would likely know about bottle feeding techniques that help to preserve the breastfeeding relationship. Perhaps discuss your concerns with her?


    Quote Originally Posted by Sadietoo View Post
    The lactation consultant suggested today that I use a shield to ease the transition between breast and bottle (she also said that my nipples were a little on the "flat" side...lovely, I know ), and baby did really good with it the 3 times I nursed him today.
    Do you mean that with the shield he as actively feeding longer? If so, that is a good thing!

    Quote Originally Posted by Sadietoo View Post
    But now I'm wondering if the shield is such a good idea. What do you think? Is it ok for him to get used to the shield or would it be best just to keep trying without it until he stays awake the whole time? Will I ever be able to breastfeed without the shield? My baby is moving out of the NICU tomorrow and will be transfered to the pediatrics floor, so I will most likely be able to share a room with him and have a little bit more freedom as far as when and how often I nurse him (he's now on a strict 3 hours feeding schedule).
    Nipple shields of today are much different than the latex versions of yore. Research has shown that used judiciously and for valid reasons, they can be a useful tool to save, and even build, the breastfeeding relationship. If nipple shields are helping, then do not be afraid to use them. You won't have to feed with a shield forever. Think of it as a vehicle to move you through the first stages of your breastfeeding relationship.

    Here are some helpful resources:
    http://www.medela.com/NewFiles/faq/premienipshld.html (commercial site, but evidence-based info)
    http://www.wiessinger.baka.com/bfing...nipshield.html
    http://www.kellymom.com/bf/concerns/...an-shield.html


    Quote Originally Posted by Sadietoo View Post
    What do you recommend I do. Keep up with the shield since it works well, or nurse without it to get baby used to it? Do you think I'll be able to breastfeed 100 % of the time when I take him home? OR will I always have to alternate with bottles?
    What does your IBCLC recommend regarding the nipple shields? Have you expressed your concerns to her? Did she explain to you the benefits of using a nipple shield, how to use it properly, ect?

    I don't have all of the details of your baby's health or your breastfeeding experience thus far, but based on your attitude and your determination, I would say that you have an EXCELLENT chance of breastfeeding 100% of the time. Even if you have to continue to supplement for a little while until your baby is gaining well, do know that you still have an excellent chance of being able to breastfeed 100% in the future.

    Quote Originally Posted by Sadietoo View Post
    This whole ordeal has been so hard on me, I always thought I would breastfeed from day one, but instead, it's a constant battle to even get the nurses to let me breastfeed, and when I do, it's with 20 people in the room working with other babies, bright lights and machines beeping, a lactation consultant starring at me....etc.
    That sounds very difficult. Do you have a support system?

    Quote Originally Posted by Sadietoo View Post
    I can't wait until I get my little one at home! Please tell me my efforts are going to be worth it in the end!
    We can't wait for you to bring your baby boy home, either. What an exciting day that will be!

    And your efforts will be TOTALLY worth it in the end.

    Please keep us updated on your progress. And don't hesitate to come back for more info/support. You can find local support via your nearest local LLL Leader by going to our homepage and selecting a region from the drop down menu. http://www.lalecheleague.org

  7. #7
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    Nov 2006
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    Default Re: Preemie in NICU - nipple confusion?

    I have my LO sleeping in my other arm as I type this, so please forgive any typos.

    My DS was born at 35 weeks an was taken to the level II nursery right away after my c-section. I never said no bottles or pacis, so for the first 10 hours of his life, this is what he got. When I finally was up and moving, my nurse took me to the nursery. Latching never really worked at the hospital, even after my milk came in, and with a whole army of nurses and one LC trying to help. I went home very frustrated but determined. Luckily, my LO came home with me.

    The weekend was a nightmare. I couldn't get anything to work, so first thing Monday morning, my DH went out, rented me a hospital grade pump, and made me an appointment with another LC for the next day. She explained that preemies aren't fully developed and have trouble with latching, and after we tried different positions, she, too, gave me a shield. Now they tried this in the hospital, and it failed, but it turned out the shield was too big... with the right size, my LO managed to suck.

    However, the next day was his first peds appointment, and he had lost too much weight what with sleeping all the time, missing feedings, and not being able to BF well, so we ended up using bottles to supplement both formula and EBM. I continued to use the shield, but it wasn't going well. Same falling asleep problem you describe.

    Fast foward to 5.5 weeks... my LO finally BF long enough to fall asleep satisfied at my breast. Granted, we were using a shield, but still, I was thrilled. It worked! Everyone had told me it would get better as he got closer to his due date, and it did. But like you, I was wondering about these shields. I had heard conflicting things from various sources, but my LC and her co-workers were insistent that it was better to use a shield and nurse than not use a shield and end up with failure-to-thrive or give up on nursing. From all I gathered, they fully expected me to not need them past 3 months.

    Fast forward to week 14. My DS, bless his little heart, weaned HIMSELF off the shields. I was completely shocked and unprepared for it. We still use it a little when he gets tired at the end of a feeding, but it continues to improve with less and less use every day. I'm still amazed by it. I was so worried that we would be using it until he was weaned.

    So the moral of my story? Nipple shields saved my nursing relationship.

  8. #8
    Join Date
    Jun 2006
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    893

    Default Re: Preemie in NICU - nipple confusion?

    Congrats on your new baby boy!!! My daughter was born at 34 weeks and spent 10 days in the hospital. I know how frustrating it can be.
    Something about preemies, they sleep and sleep and sleep - no matter what you try to do, they sleep. Don't feel bad when you are nursing and he goes to sleep, it happens, just try to wake him back up. Also with preemies, unlike full term newborns, you HAVE to wake them up to eat/nurse or they will once again, sleep through everything, usually on a schedual at first and then basically when they get to term age (40 weeks) you can go on a baby led approach with nursings, unless there is a weight gain problem.
    I was also informed in the NICU that I have flat nipples and it was suggested I use a shield after my daughter could not get latched on. I did and from then on out, she latched on with the shield. Something about preemies, they sleep and sleep and sleep - no matter what you try to do, they sleep. Don't feel back when you are nursing and he goes to sleep, it happens, just try t wake him back up. Also with preemies, unlike full term newborns, you HAVE to wake them up to eat/nurse or they will once again, sleep through everything. We did in fact have trouble weaning from it, ever time we started the weaning process of the shield, she ended up back in the hospital (not due to weaning, but for other health issues that we are still fighting with today) and with her in a unfamiliar place, she would not latch on without it. After so many months of back and forth to the hospital, I gave up the weaning process from the shield (and failed attemps with LLL Leaders, LC, Occupational Thearpist, Speech Thearpist, etc...trying to help her get off of the shield).
    It does not cause the problems of yesteryear like many people think. I have a overproduction of milk and donate to local milk banks, still with using the shield.
    BTW - my daughter is 15 months old....Good Luck to you!!!

  9. #9
    Join Date
    Dec 2006
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    16

    Default Re: Preemie in NICU - nipple confusion?

    You have gotten good advice here already! I just want to add, I am now home with my son who was born at 32 weeks and we had the same issues. At my hospital, they tube fed, then let me breast feed some, then tried introducing the bottle. My little guy fell asleep like yours, and was not great with the bottle, so that feeding tube stayed in his nose for quite a while. We would tickle him, undress him, use cold cloths, etc. to wake him back up. It made him mad but it generally worked and he would eat more.

    If you're really concerned about nipple confusion, maybe ask about the NG tube for the feedings where you can't be there.. no worries about tiring out the baby with a tube feeding, either.

    It was a long, tiring road, but my son is now breastfeeding all the time with the shield, except that for the 3 AM feeding I let my husband bottlefeed him some EBM, and I pump and go back to sleep. He is growing & gaining weight fine. You can do this, and you are on the right track!

    --Mrs. M.

  10. #10
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    Oct 2006
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    Default Re: Preemie in NICU - nipple confusion?

    Congrats on your sweetie! I wont go into all of our bf troubles with my 28 weeker, but i would not give up. I can't tell you how rewarding it is to have persevered through the hard times and coming out on the other end with a very healthy breastfeeder. Id say stick with the sheild, and dont give it a 2nd thought until he is at least 40 weeks and gaining well. It isnt hard to wean them off the sheild. Just keep pumping to keep your supply up. You are almost near the end of your hospital stay, hang in there! Good luck and congrats!

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