How many of you have a written informed consent form like the following for
patients to read who request formula supplementation?  The use of the form has
done two things:  (1) reduced the number of formula/bottles of glucose water
supplementaton and (2) reduced the number of pacifiers given out routinely.
By falling back on the AMA Guidelines, pediatricians didn't balk.  Nurses did
though.

It goes like this:

"The American Academy of Pediatrics states that routine supplementation of
formula or glucose water for the full term, healthy breastfed infant is not
necessary.  In recognition of the recommendation, the staff at ABC Hospital
does not routinely supplement infants with water or formula for the following
reasons:

1.  The more the baby nurses, the more milk the mother will produce.  Sugar
water
      or formula supplements may interfere with the nursing infants appetite
for BF,
      which can lead to a diminished milk supply.

2.  Studies have shown that feeding a healthy term newborn on cue, without
     supplements, encourages early milk production (24-48 hours), decreases
      incidences of jaundice and promotes better weight gain for infants.

Artificial nipples require a different sucking action than suckling at the
breast.
Sucking on a bottle can also confuse some babies as they learn to breastfeed.
For these reasons, pacifiers/bottles are not recommended in the early weeks.

In our efforts to promote breastfeeding and encourage proper latch-on to the
breast,
when supplementation is deemed necessary for breastfed infants, alternative
feeding methods (cup, finger-syringe feeding, feeding tube device) shall be
used.

I, _________________, request the nurses to supplement my infant,
______________, with ______________________(glucose water, formula).  I,
__________________, request the use of pacifiers for my infant.

Signature of parent ____________________    Date _________________________