I'm having a really bad day and need to vent to others who can
understand!

First baby I see today is having a hard time feeding from the bottle.
He's a 2 week old cardiac surgery baby whose mom is pumping and
feeding from a bottle (also gets feeds in a tube). I noticed a short
frenulum 2 days ago while putting the baby to breast. Informed the
parents and put a note in the medical chart.  Yesterday the resident
calls me and wants more information so I provided him with an article.
Today the cardiology attending told me that they discussed it on rounds
and decided not to risk endocarditis (but circumcision is ok!)  Then I
read his note in the chart that the "lactation consultant continues to
press her case for depriving the baby of his frenulum to breastfeed."
He then writes that he examined the baby's tongue and it doesn't seem
to interfere with sucking.  Does he even know what to look for???

Then I get a call from a nurse about a GI patient who was
breastfeeding and now has allergies and mom needs help weaning.
She said I needed to call the GI doc first to discuss.  Turns out that
baby breastfed for 6 months and was thriving.  Mom gave baby some
cow's milk formula and the baby ended up in a different hospital with
severe diarrhea.   After 2 weeks the docs there said that some breast
milk couldn't hurt so they let mom breastfeed.  Baby almost died!  Now
the baby's here with protein losing enteropathy and severe edema.  So
the doc says to me "the baby breastfed for 6 months, that's enough
anyway".  I went on to explain that many babies breastfeed into the
second year and continue to benefit because of the close bond
between mom and baby, and the baby also receives antibodies to
protect against infection.  He replied that he agrees with the first
reason, but the second reason's wrong and there's no way the baby
gets increased immunity via breast milk. He acknowledged that we'd
never agree on that.  Where do they get their info from?

Then I had a mom with a 6 day old baby readmitted with hyperbili
yesterday (bili of 23).  Pediatrician told mom not to breastfeed for 24
hours so now mom thinks her milk isn't good for the baby.  The mom
didn't even want to pump and bottlefeed, just wanted to give formula.  I
spoke with the pediatrician who said she always tells moms to stop
breastfeeding for 24 hours when the bili is going up because there's
something in the breast milk that makes jaundice worse.  (Isn't this late
onset only, and isn't the treatment to still breastfeed?) She said that the
bili always comes down when they stop breastfeeding.  Well, I said, it's
because the baby got lots of milk and stooled.  Would have happened
also if the baby gots lots of breast milk, but usually these babies are too
sleepy to get good feeds at the breast.  I'm not sure if I convinced her
or not.

Oh well. Back to work.  Thanks for listening.  There's nothing like
sharing with others who can truly understand!

Rachelle Lessen, RD, IBCLC
Philadelphia, PA  USA      mailto:[log in to unmask]