I don't work in the NICU, so I don't know if my comments will be of
interest to you or not. However, I have a 15 month old who has had 3
minor surgeries and 2 major surgeries---usually on his urinary tract.
I'm also not sure if this information will be pertinent since the
baby's surgery is on the bowel.
After ever surgery my son has been permitted to breastfeed directly or
take breastmilk (if his suck was still too uncoordinated) as soon as he
felt ready...which is always right away. This was true at ages: 10
days, 30 days, 46 days, 1 year, and 13.5 months.
I have also had a case where the nurse was willing to let him nurse as
long as he didn't begin to vomit. My son has never vomited breastmilk,
but he has vomited pedialyte and apple juice. (This might be a good
point to make---that breastmilk is antinauseating.)
I have had another case where is suck was very uncoordinated, and I was
able to convince the nurse that he wasn't gulping milk so was ok.
From my person experience, the person to go to is the Surgeon. The
surgeon can write the orders for the baby to be permitted to breastfeed
immediately on waking. Working with the surgeon is key to a successful
surgery as well as FEELING the surgery was successful. I find surgeons
to be very reasonable, but they like quick facts that are precise and
to the point. If the mother can put forward a good case to the
surgeon, and if the surgeon does not have any medical reason that it is
not possible, then the surgeon will usually help the mother get what
she wants. It will also help for her to remind others of what the
surgeon told her.
Some general things about breastfed babies and surgery:
Remind the mother to pump every two hours while the baby is NPO and in
surgery. If the baby continues to have an uncoordinated suck for long
after surgery, pump afterwards until baby's mouth returns to normal.
Let the mother know that the baby's sucking mechanism needs to be
closely monitored after having endotracheal anesthesia. It was
mentioned to me by the former surgeon and the new SLP well after the
fact that endotracheal anesthesia can cause the infant to protect their
airway thus altering their ability to breastfeed. This can be fixed
with the help of a good speech language pathologist, but it is much
easier to fix if caught earlier than later.
Remind the mother that it is her baby. Even a breastfeeding mother
tends to lose this I think when there is surgery involved with the
baby. There is a detachment process that is involved with every
surgery. Holding the baby close to the breast afterwards is very
healing no matter if the baby is permitted or can nurse or not.
And in the words of my baby's surgeon: "You don't have to convince them
of anything. You tell them what they can and cannot do, what you will
and will not allow." I find that when following this advice, the
medical staff is more likely to treat me as (a) an adult and (b) a
partner in my child's care and health.
One last thing: I found an article on Kellymom.com that was helpful:
Breastfeeding the Hospitalized Baby by Cyndi Egbert. That and general
info about surgery for the baby can be found here:
http://www.kellymom.com/health/illness/baby-surgery.html
Katie Bredbeck
PS: For sedation procedures (of which he has had 10 or more), the
nurses seem less likely to permit breastfeeding immediately --- they
want him to have pedialyte or apple juice first. It depends on the
nurse though, and the doctor ordering the procedure and the procedure
itself. I also find with sedation that his suck is less coordinated.
On Thursday, July 14, 2005, at 05:49 PM, Sharon Knorr wrote:
>
> Just got back from ILCA and am working on a new case sent to me by
> email.
> Can any of you who work in the NICU give me some guidance here? I
> have been
> unable to get detailed info yet, but the basic question is, what is the
> standard of care for post operative feedings for a breastfed baby?
> Baby had
> part of bowel removed. Plan is to start with Pedilyte, then pedilyte
> plus
> breastmilk and then exclusive breastmilk. Is this pretty standard
> treatment? I know for adults you get nothing, then clear fluids, then
> soft
> foods and back to a normal diet as tolerated. I know that most
> institutions
> do not consider breastmilk to be a clear fluid. Mom would like to go
> directly to breastmilk from IV. Any guidance would be appreciated.
>
> BTW, both the LLLI and ILCA conferences were wonderful. Had a great
> time
> and enjoyed talking with many of the folks from Lactnet. Hope that
> you all
> had a nice and safe trip home.
>
> Warmly,
> Sharon Knorr, BS, IBCLC
> Newark, New York
>
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