My client's baby was severly brain damaged at birth. She wasn't expected to live, was on support systems for breathing, clearing lungs, and nutrition. At one time the family was ready to make a decision about ceasing the supports and say goodby to her. On that day, baby showed some "improvement" so the HCPs advised against stopping the supports. She was sent home to die on her own--with all of the machines. She is still living, of course, taking every minute of this family's time and energy. She requires 24 hour observation of parents or home health nurses. Baby has had only breastmilk in her feeding tubes for these 6 months. She still is on all of the supports. She is showing some "improvement" now and is not expected to die. Up until now, everyone left the mother alone concerning nutrition, but all at once, the gastroentologist and Ped are concerned that breastmilk is not adequate nutrition for her and she needs to receive fortifiers for proper nutrition. Mom says that so long as they thought she would die, her milk was ok, but now they want to get in on her nutrition. She is mad. But she also wants to nourish her baby the best she can. She b'fed her older child and started solids when he was ready to be at the table, focusing on iron-rich foods. She called to ask about this little one and her iron stores and possible need for additional nutrients. Obviously, the usual readiness for solids will not be evident and the MDs are doubting the adequacy of breastmilk. She has GI disturbances which have been eased by mother's diet adjustments and Mother is reluctant to introduce something foreign. I had a couple of suggestions. One was to take baby's saliva a few times a day and put it on mom's nipples to "program" the nutrients more closely to what baby needs daily. The other was to have a blood test to check the hemoglobin before considering supplementing. Baby was term and should have adequate iron stores for an extended time, especially since she has had only breastmilk for her 6 months. I don't know that any of you have dealt with such a tragic case, but do you have any ideas for this mom about the extent of nutritional sufficiency of breastmilk? On Lactnet we have tossed around the subject of delayed solids, and I have my own daughter's story of her high heme count at 11 months, but what do you think is in the nutritional future of this little girl? Any thoughts will be most appreciated by this heroic mom. Pat Gima, IBCLC Milwaukee Wisconsin mailto:[log in to unmask] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html