We are seeing a majority of premature babies being discharged from the 
NICU and told to bottle feed. Special formula is prescribed and mom's 
milk is often discouraged. Sometimes the mothers milk is fortified with 
the special formula.

Many of these babies are already overweight looking so this is not just 
the thin ones. By overweight, that means big arms, big thighs, fat faces 
and necks, round bellies on a baby who is at adjusted age of 35-36 
weeks. We see a lot of large bottle feeds for these babies, for example 
a 5 pound baby is discharged with instructions for mom to feed 3 ounces 
formula every 3 hours or 8 times a day. I have had moms tell me the 
doctor tells her the baby should gain a pound a week! (sometimes this is 
the pediatrician) This baby will not breastfeed because he has learned 
not to suck on the bottle to slow the flow and is being over fed and not 
allowed to self limit to normal amounts. Baby usually gulps and gasps 
with these bottle feeds.

I see a huge disconnect between the hospital staff telling mom to pump 
for her premature baby right after birth because her milk is best and 
then the baby coming home after having breastfed once or not at all. 
Baby is discharged only with bottle instructions and most of my WIC 
clients just give up at this point. We loan her an Ameda Elite pump 
while her baby is in the NICU but she won't breastfeed upon discharge. I 
do not see this pump loan program as increasing our bf rates, mostly 
because the focus from the hospital is bottles and mom is given the 
impression by the hospital that bottles and formula is better than 
trying to breastfeed. Excellent LC help is given by our WIC, so this is 
not the problem.

Kathy Eng, BSW, IBCLC

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