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PAPERS: Carmel T Collins, Philip Ryan, Caroline A Crowther, Andrew J McPhee, Susan Paterson, and Janet E Hiller Effect of bottles, cups, and dummies on breast feeding in preterm infants: a randomised controlled trial BMJ 2004; 329: 193-198 [Abstract] [Full text]

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It's not what you do but the way that you do it...?

Carol Bartle   (29 June 2004)

It's not what you do but the way that you do it...? 29 June 2004
Carol Bartle, Research Fellow Christchurch Women's Hospital Send response to journal: Re: It's not what you do but the way that you do it...?	I am pleased that the authors have added some support to the theory that avoiding bottles increases the success of breastfeeding. As a NICU practitioner of nineteen years, midwife and Lactation Consultant, I am certainly not suggesting that babies should be given bottles and/or pacifiers without consideration but I wonder if it could be the 'way that you do it' that is as significant as 'what you do'. I find that if you encourage babies to open their mouths wide for a pacifier then they are more likely to do this for a breast. The baby needs to be encouraged towards a wide 'gape' and a 'rooting' response so that this is 'programmed' feeding behaviour. When a baby gets accustomed to only opening the mouth a little for a pacifier to 'enter', it makes latching at the breast a more frustrating exercise. I have not conducted a study but would be interested to hear thoughts from the authors and others about this aspect. Perhaps NICU researchers could continue work in the area of 'non- nutritive suckling' on a recently expressed breast for preterm babies not yet ready for full breastfeeds? Narayanan et al (1991) found that this 'non-nutritive suckling' on the breast appeared to promote lactation and supported a longer duration of breastfeeding. In the end I suggest that it is the contact between mother and baby that fosters the breastfeeding relationship and anything you can do to facilitate this contact will be beneficial. Thomas (1996) poses a question about NICUs and Kangaroo Mother Care and wonders if pacifiers would be as necessary in NICUs if we practised more KMC. I would add that the KMC probably needs to be practiced in a less restricted manner than in most NICUs. There seems to be a tendency to practice KMC in a 'token' way and in the level 3 area only in many units. References Narayanan I.,Mehta R., Choudhury D.K.,& Jain B.K. (1991) Sucking on the 'emptied' breast: non-nutritive sucking with a difference. Archives of Disease in Childhood, 66,241-244. Thomas S. (1996) Contemplating Baby-Friendly in the NICU? Neonatal Network, 15(4).50. Competing interests: None declared