1.  Last I heard, the AAP considered breastmilk to be a "clear fluid".  
Personal experience here: DS2 was diagnosed with RSV at 10wks.  At hospital, I was 
told "no formula".  When I told them he was exclusively breastfed, they showed 
me a trifold that shows what to feeds infants with RSV.  Formula-fed infants 
get IV fluids only until congestion clears, exclusively breastfed infants 
continue to nurse because the AAP says it's a clear fluid, and won't hurt the 
congestion.  I don't have that trifold anymore, though.  Maybe we can find the AAP 
reference that says it's a clear fluid and show this doc.  I won't have time 
to search until naptime, later today.

2.  Did he see Dr. Hale's book?  Or did mother just tell him about it?  He 
needs to *see* a copy of the book, and other recommendations that his book is 
good info.  

3.  Suggestions: normal stuff to increase baby's milk intake.  Sleep in same 
room, so baby can nurse more at night.  Pump and nurse at same time to take 
advantage of letdown. Suggest breast compressions during pumping to increase 
amount pumped.  When pumping, wait for second or third letdown.  Make sure 
flanges on pump fit correctly.  You didn't mention which pump she's been using 
(before trying the Whisper Wear), but make sure she's using a quality pump.  Maybe 
put her on a rental for a month to help her supply.  

That's all I can think of so early in the morning, before I've had my coffee. 
 I'm sure others will have more info.  

Shannon Rittenhouse
Sterling, VA

In a message dated 10/12/2005 9:29:16 PM Eastern Daylight Time, 
[log in to unmask] writes:
1. Mother takes baby to ER, diagnosis Bronchitis. Baby is one week shy of 
one year of age. The physician states I can't believe you are still 
breastfeeding! In the instructions to the mother is clear liquids, 
absolutely no breastfeeding! He even circled it and had the nurse restate 
it for her as if she couldn't comprehend or read. Her baby wants to nurse 
and he is refusing other forms of diet. His rationale is that the milk 
will cause more thick secretions. The mother comes up to me very upset. I 
asked her can he breathe when he is nursing? She said yes. I asked her 
does he sound worse after he nurses she said no. I said give him the 
antibiotics and let him get the one nourishment he loves and needs. And he 
needs fluids as much as he will take. I asked her if she had a vaporizer 
or cold steamer. She said no. I told her that the warm shower running to 
steam up the bathroom may also help his congestion. I need some good 
references for composition of breast milk to show this man. If I have 
overstepped my bounds I guess I need you to tell me that too.
2. A patient comes into surgery for an exploratory lap r/o appendix. She 
also has a baby that is close to six months of age. The anesthesiologist 
is aware that she is breastfeeding before she even gets to OR. He tells 
her she won't be able to breastfeed for 48 hrs. Just a reference in Dr. 
Hale's book doesn't seem to be enough for these guys. I called the 
anesthesiologist and told him my understanding that with general 
anesthetic for these procedures that if she is awake and alert she can 
breastfeed. He compromised and told me 24 hrs. Are there protocols 
somewhere to assist these patients?
3. I have a 11 wk infant that has been gaining weight very slowly. The mom 
was seen by the peer counselor and referred to me after having her 
physician start her on Reglan. She works in a day care. She doesn't always 
get time to pump and at times tries to go and feed him the days he is 
there. The most milk she is pumping is 4 oz. I had her in my office and 
did a pre and post weight. Baby was up only 4 oz from one weeks weight 
check. He had nursed 2 hrs prior to coming to me. His weight was up only 2 
oz. from that feeding. I have asked her to use a sns with the breastmilk 
she is pumping, so that he will obtain more calories per feeding. He is 
happy, he has good skin tugor, not fussy at any time. Nurses on demand at 
home and on weekends without supplements. I thought he was probably 
getting minimum feedings in 24 hrs. 6-7. He is growing in inches and head 
circumference. I had her try a whisper wear pump at work so she could be 
pumping throughout her day and not have to leave to pump. She said she got 
less than when she just goes and pumps 4 oz. in the morning. She will be 
in to see me tomorrow and we will evaluate the whisper wear pump whether 
or not it is effective. She has great nipples and breasts. Two siblings 
she nursed for 4-6 months with no supply issues. 

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