Dear Lactnet Friends:

Oh I LOVE this:

"This baby should be evaluated by gastroenterology if the baby's liver
enzymes are abnormal, and the pediatrician is done with his/her part of the
workup. The baby could have something like biliary atresia, cholestasis,
cystic fibrosis, alpha-1- antitrypsin deficiency, etc, in addition to
infection as possible causes. Also, make sure that the baby is not having
liver toxicity from a maternal medication.
I definitely would not assume that the breastmilk is low in calories. If it
was, the baby would strive to take more. Blaming breastmilk does not make
sense to me.
I absolutely don't agree with adding formula to breastmilk. I don't
understand why doctors do this. If a formula fed infant was not taking
enough formula, the doctor would say to give more formula, unless the baby
has lung or heart disease and is fluid restricted. They don't say to
concentrate the formula.
So, if this baby needs more calories, the calories should be given in a
physiologic manner, by giving more breastmilk, or normally reconstituted
formula if there is not enough breastmilk. Here is my reasoning:
1. the baby also needs free water if the baby is not taking enough volume
for sufficient growth
2. Summer is approaching, so a very bad idea to limit volume
3. Infants who take breastmilk with added formula tend to have stomach
upset and don't eat as well overall (from my experience)
4. The doctor is essentially taking the baby off the breast by expecting
mom to give EBM with added formula, jeopardizing her supply
5. There is no evidence that this is safe!
​"

Dr. Eglash, may I have permission to share this fabulous post with my local
professional group, crediting you of course?

I see this advice as reflecting a fundamental distrust of human milk. I
hope this goes away in my lifetime.

warmly,

​
-- 
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
Reviews Editor,* Clinical Lactation*
www.nikkileehealth.com
https://www.facebook.com/nikkileehealth
*Communications are confidential and meant only for whom they are
addressed.*

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