In our hospital, if a neonatologist who is breastfeeding friendly notes
a baby with a t-t, he or she will clip it. We are working on a
procedure/policy to tell nurses how to properly assist the MD. (That
means, using a shoulder roll to support the baby's neck in an extended
position so frenulum is easily accessible.) Some MD's want the baby to
have sweet-ease. What our usual procedure is, at least in the
outpatient clinic, weigh, latch the baby, weigh. Dr. comes in and does
the snip, then before he/she leaves the baby is back to the breast and
the mom tells the doctor if it works or not, if it's better. More
snipping if needed, but usually not. Some very good neos can do a
decent digital assessment and tell what more needs to happen. HOWEVER -
if the baby has had sweetease, often they are no longer interested and
you can't assess right then. Also, back to the breast is immediate
tamponading of any bleeder present. If a baby has a weak suck as a
result of long-term compensatory sucking, we have the mom use a
SpecialNeeds Feeder. When babies are getting milk by compression
instead of sucking, it works well and you can control the flow rate.
When the baby starts curling the tongue correctly and is no longer
compressing, the baby can get milk from the feeder even on the "no-flow"
setting. This is my observation only from my experiments with these
over the last 19 or 20 years that they have been available (we got them
from England originally, before Medela). At first, I thought it was a
fault in the design, but after testing these with pumps (ala Karen
Gromada's research), I realized the logic of the design. It works like
it's supposed to! If you looked at Dee Kassing's articles in JHL in
2002 on paced bottle-feeding (I like to call it baby-led
bottle-feeding), you get the picture of how proper bottle-feeding can
actually help a baby who has an uncoordinated or weak suck to improve or
retrain a baby who has only been compressing the breast. This is why we
do NOT use wide-mouth bottles with short nipples - since they often
encourage nipple compression by facilitating the bite reflex.
Jane in Tennessee
-----Original Message-----
From: Lactation Information and Discussion
[mailto:[log in to unmask]] On Behalf Of Deanne Lawson RN,
IBCLC
Sent: Wednesday, March 12, 2008 9:44 AM
Subject: Re: "sweet-ease" on nips
In regards to use of "sweat-ease" on the nipples: I have looked into
research on the same issue. Directly there is none however it takes
only a small amount of the 24% sucrose to produce the natural opiates
that are released when combined with suckling. Typical dosing is 0.2 to
1.0 ml (for a very painful procedure.)
When dose the "drop" on the nipples become more and then potentially
have a sedative affect. Consider that colostrum has 20-31g/L of lactose
that may be more appropriate if available.
About 1 1/2 years ago our staff became over zealous in this practice and
there was a direct relationship to "sleepier" babies. I also saw more
gassy or even "colicy" type behavior also which I attribute to excess
"sugar" in the gut.
The Journal of Human Lactation 18(3) 2002 has an article on
breastfeeding analgesic that you may find some references of interest.
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email:
set lactnet nomail 2. To start it again: set lactnet mail 3. To
unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules
and directions: get lactnet welcome
***********************************************
Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome
|
