Felicia has shared a distressing situation in her hospital regarding
non-evidence-based breastfeeding practices. Here are some thoughts in no
particular order:

1. As an IBCLC your practice and ethical guidelines require you to be able
to assess breastfeeding. You can most certainly observe altered tongue
function and document this in the record as it is within your scope of
practice. Tongue-tie or ankyloglossia is a diagnosis. Altered tongue
function is an observation.

2. Ordering a bottle of infant formula for all LGA, SGA, and infants with
elevated bilirubin lacks evidence for this practice. You would need to ask
for the evidence. It is also incumbent upon the hospital to inform patients
of the side effects or hazards of any treatment--in this case the use of a
bottle and infant formula. Are patients informed that a bottle has the
potential to cause bradycardia during feedings? Are mothers informed that
the use of infant formula alters the infant gut microbiome to one of
inflammation and increases the risk for infection and autoimmune disease?
If a mother is not informed of these risks, the potential exists for
liability on the part of the hospital if the infant experiences diseases or
conditions that can be attributed to gut dysregulation. Do the mothers sign
a consent to supplement form with all of the risks declared?

3. You might wish to talk with your Risk Management Department relative to
the hospital's liability in treating infants without parental consent and
failure to advise regarding potential side effects of such treatment.

4. You could also speak with your Quality Improvement Department regarding
the sub-optimal breastfeeding practices on your unit.

Marsha Walker, RN, IBCLC
Weston, MA

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