Mothers almost always recognize when their babies are doing poorly. Mothers
often cry and feel guilt or failure when the breastfeeding goes awry and
they have to supplement. Usually mothers will respond positively when we
acknowledge their feelings of sadness or defeat over not being able, at
that moment, provide what their babies need from their breasts. But, even
through their tears, they will mobilize and provide the calories to the
baby and carry out the lactation and/or medical followup. Mothers need
abundant support and we reflect back to them and validate those feelings.

However, in the 2 cases we discussed this week, the mothers' reactions or
non-reactions,  were not normal reactions. So we need to recognize that
this is likely a mental health issue, almost like anorexia nervosa, in
which a person sees herself as fat, when in fact she is very
undernourished.

Once in a while a mother will not react in an appropriate way, and this
will require a higher level of intervention, be it a mental health consult,
bringing in the family to intervene, the pediatrician, obstetrician, social
worker, or whatever. Not providing food to the infant is child neglect,
whether intentional or irrational and we must intervene.

Laurie Wheeler RN MN IBCLC
New Orleans Louisiana and Mississippi Gulf Coast, USA

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