Friends,

This is NOT a post on circumcision, but I am going to have to mention the
word a few times.  I attended a mother-baby conference today, sponsored by my
hospital and our sister institution.  Among the sponsors was a company called
Children's Medical Ventures: A Novametrix Company.  They had a table
displaying their products, including one called Sweet-Ease.  Will get back to
it in a minute.

JCAHO (That delightful organization that accredits hospitals in the US and
causes said hospitals to quake in their boots) has mandated that hospitals
address the issue of pain in all of their patients.  A worthy cause.  On
mother/baby, we have to document our patients' self described pain at least
once every 8 hours and report what we did to alleviate any pain over 3 on a
0-10 scale, be it pain medication, ice to the perineum, topicals, heat,
repositioning, et cetera.  For the most part, a good thing.  We also have to
do this with our babies, with a 0-5 scale.  0 being sleeping contentedly or
happily eating or cooing.  5 a frantic, crying baby.  OK.  Every baby gets a
0 at some point in an 8 hr shift.  EXCEPT when they get circumcised.  (I
know, babies cry for other reasons, but no nurse is going to document THAT!)
So all hospitals in the US have to have a plan to deal with circumcision
pain, or JCAHO is going to be very unhappy.  I learned today, that in
addition to Emla cream (A local anesthetic that works a little bit, but it
has to be put on 30-60 minutes before the procedure.  So the OB, who does the
circs in my neck of the woods, has to tell the nursery ahead of time when he
or she is going to do it.  How inconvenient!) and a pudendal type block (Even
more time consuming and inconvenient for the OB, quite effective, but not
without potential side effects), the MD may chose to use this Sweet-Ease,
dipped in a pacifier and given to the baby to suck on during the procedure.
You KNOW they didn't consult lactation about this!

Sweet-Ease is a 24% sucrose solution.  They claim it "helps to calm and
soothe babies in distress or during painful procedures."  They back up this
claim with two studies:

Blass EM., Smith BA. Differential Effects of Sucrose, Fructose, Glucose, and
Lactose on Crying in 1-to-3-Day-Old Human Infants: Qualitative and
Quantitative Considerations.  Developmental Psychology. 1992, Vol. 26, No.5,
804-810.

Smith BA., Fillion TJ., Blass EM.  Orally Mediated Sources of Calming in
1-to-3-Day-Old Human Infants.  Developmental Psychology. 1990, Vol. 26, No.
5, 731-737.

I am sorry to say that my hospital has bought their sales pitch and ordered
this stuff.  And I am confident that most of the doctors will choose this
option for "pain management" during circumcision, because it requires no
extra time from them and they have been told they have to use "something."
What an especially stupid way to try to mess up breastfeeding!  To quote
Jack, agghhh!

Thought I'd give you all a heads up.  If you want to be more aggravated, they
have a website:  www.childmed.com

Very sad in hot, sunny New Jersey,
Kim

Kim Block RN, MSN, IBCLC
Who is too embarrassed today to write down where she works.

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