I need your collective wisdom on this one.  I'm asking with the mother's
permission.

Mom has two sets of twins:
        identical girls, 4 years old.  (Nursed them for about 1 year).
        fraternal boy-girl twins, 7 months old.  (Still nursing).
Mother had returned to work as a post office letter carrier, rural district.
Worked through the problems of one baby who wouldn't take a bottle, need
for her to work extra hours over the Christmas rush, child care, flexible
schedule, etc.

Last week one of the 4 year olds was diagnosed with acute lymphocytic leukemia.
Mom spent a lot of time with her in the hospital, separated from babies.
Used her P-n-S, but with the separation, stress, and irregular pumping, she
went from getting 8 ounces per breast each pumping time to less than 3
ounces.  Frozen milk supply at home was about gone.

We talked about ways to build up her milk supply with frequent pumping and
snuggling in with all 4 kids at home again. (Child was discharged from
hospital on Thursday, April 23.)  Milk supply is rebounding now.  Babies
have gotten used to bottles.  They eat solid foods as well.  Now are
nursing maybe 4 times a day.  I encouraged this mom to keep them interested
as much as possible.  If they stop nursing, there is more risk of them
getting sick and then exposing their older sister to infections at home.
Nursing times can also help calm everyone down amidst all this stress.

Mom is especially concerned over her daughter's low immune status at this
time.  Child is on prednisone and several other meds. (Mom is looking up
names for me.)
The question for all of you is, would it be of any help to give breast milk
to this 4 year old?  Mother thought it would be something she could do to
help.  There are some viruses that can pass through the milk, but she would
probably be exposed to them in other ways if they were present in the home
environment.  And  antibodies in the milk should protect against lots of
other pathogens for a child with a weakened immune system.  I think that if
a baby or nursing toddler/preschooler was diagnosed with leukemia, they
would continue to nurse.  So I could not think of any reason that giving
the mother's breastmilk would be of any harm, and might be of help for this
4 year old at this time. I suggested the mother ask the physicians about
this.  She says they know she is nursing twin babies and wonders why they
didn't suggest this idea.  What do you all think about it?

Mom also wonders how she would get her daughter to take the milk.  She
believes she would refuse to drink it.  Appetite has decreased
dramatically, although she seems to want to eat spicy foods like brats
(Wisconsin sausages) and pickles.  Would fresh milk be best?  (Maybe use it
to make instant puddings or milk shakes?)  What effect would heating or
freezing have on the ability to protect this child from infection?


Mother is worried that the identical twin sister will be at increased risk
of getting leukemia as well.  I don't know about that.  The ill child is
allergic to peanuts and her twin is not. I always wonder about how
accurately twins are identified as identical or fraternal, unless tissue
typing is done. Some fraternals can look very similar.  And not all
identical twins get the same illnesses.

Anne Altshuler, RN, MS, IBCLC and LLL leader in Madison, WI
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