July 11, 2012
Helping babies improve negative pressure sucking after frenotomy:

While many infants suck properly within days of a frenotomy, some continue to suck weakly, with poor suction (negative) pressures. One method to help gradually increase sucking pressures is to slowly increase the amount of vacuum the baby needs to exert to get milk. One way to do this is to use a lactation aid consisting of a 36 inch 5-french feeding tube placed in a bottle of milk.

At first, hold the bottle high well above the breast so milk will flow down the tubing easily. Find a position for the bottle where the baby uses a 1:1 or 2:1 suck:swallow ratio with a soft, unstressed swallow. Then move the bottle down an inch or two, so the baby needs to work a little harder to generate the same flow. Assess to ensure that the baby is getting sufficient milk (less than 3:1 suck:swallow ratio during active sucking).

Show the baby's mother how to identify active feeding. Advise her to lower the bottle another inch or two every day or so, as the baby tolerates. If the baby gets fussy or fails to have a good feeding, she will need to raise the bottle higher. She may find that the baby needs less assistance at some feedings (typically first thing in the morning when the breasts are more full, and when well rested after a nap) and more help at others. This is fine. We expect that over the course of several days or weeks, the baby will be able to exert sufficient vacuum to breastfeed without the lactation aid. If little to no progress is made, assess the baby again to ensure that there are no other anatomical or medical challenges.

More information on different lactation aids/nursing supplementers and nuances of their use can be found in Selecting and Using Breastfeeding Tools.

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