At 07:01 PM 5/17/96 -0400, you wrote:
>There are 16 messages totalling 435 lines in this issue.
>
>Topics in this special issue:
>
> 1. Gastrointestinal Reflux
> 2. Jaundice
> 3. Dental Caries
> 4. LACTNET archives on the WWW
> 5. LACTNET Digest - 15 May 1996
> 6. retracted tongue
> 7. "Living on Earth" about BF
> 8. Cutting silicone nipple shields and weaning from shields
> 9. retracting tongue
> 10. Living on Earth on WWW
> 11. WWW page
> 12. jaundice
> 13. Retracting Tongue
> 14. IBCLC exam
> 15. insufficient milk supply
> 16. dental caries/retracted tongue
>
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>
>
>----------------------------------------------------------------------
>
>Date: Fri, 17 May 1996 18:49:44 +-200
>From: Carlos Gonzalez <[log in to unmask]>
>Subject: Gastrointestinal Reflux
>
>Deborah:
>How was Logan reflux diagnosed? Barium swallow?
>There is an excellent revision:
>Hillemeier AC: Gastroesophageal Reflux. Ped Clin N Amer 1996;43:197
>Excerpts from it:
>"Because most infants have some degree of GER, one should not automatically
>assume a cause-and-efect relationship between the symptoms of GER and other
>health-related conditions, such as growth problems, respiratory disease,
>apnea or behavioral problems."
>"...the correlation of apneic episodes with GER usually does not exist"
>"many infants who have little or no clinical symptoms of reflux experience
>reflux of some barium into the esophagus"
>"thickened feedings (e.g. apple juice thickened with rice cereal) were
>found to have no effect on reflux time, unless the child was in a
>head-elevated prone position after the feeding"
>"thickened feedings in some infants may result in an increased number of
>coughing episodes" (J Pediatr 1992;121:913)
>In plain English: reflux, if real, if probably only a coincidence and not
> the cause of apnea. Rice has no clear benefits, and (at 2 months age)
>many risks (intolerance, bacterial contamination, reduced breastmilk
>intake, nutrient deficiency...). If someone really thinks this infant is at
>risk of SIDS, a more sensitive approach would be to encourage exclusive
>breastfeeding, the baby sleeping in the parent's room and no one smoking at
>home.
>Best wishes Carlos Gonzalez, MD (Ped)
>
>------------------------------
>
>Date: Fri, 17 May 1996 18:12:45 +-200
>From: Carlos Gonzalez <[log in to unmask]>
>Subject: Jaundice
>
>Hello
>"Over two thirds (of British pAediatricians) would not interrupt
>breastfeeding, and most others would do so only occasionally or for less
>than 24 hours." This and much more in:
>Dodd KL: Neonatal Jaundice - a lighter touch. Arch Dis Child
>1993;68:529-533.
>It's a comment on a previous paper from Newman and Maisels (Pediatrics
>1992;89:809), and compares USA and UK current practices: "A recommendation
>that will surprise many British paediatricians is that breastfeeding be
>interrupted in well infants without haemolysis when the serum bilirrubin is
>275-425 micromol/l" (16-25 mg/100 ml). Fine sense of humour!
>I think there is also a recommendation from AAP in Pediatrics stating BF
>doesn't need to be interrupted (forgot reference, sorry!)
>Best wishes Carlos Gonzalez, ACPAM
> Barcelona
>
>
>------------------------------
>
>Date: Fri, 17 May 1996 10:16:54 -0700
>From: Thomas and Suzanne McBride <[log in to unmask]>
>Subject: Dental Caries
>
>Thanks, Melissa, for suggesting contacting Betty Crase at LLLI Center for
>Breastfeeding Information for dental and other information. I have done
>that a few times (was co-panelist with Marian Tompson this topic years ago)
>and found it helpful. Unfortunately I did not receive enough references to
>recent published information to satisfy some dentists who are advising
>weaning by 12 months. I will recontact Betty, as a year ago she provided me
>with information last year from a dentist (Dr. Torney ?spelling) who was
>looking at prenatal risk factors including maternal illness, diet and
>stress. Hoping something will be published. There is a published study
>looking at large groups of exclusively breastfed children in Africa which
>pointed to the presence of linear hypoplasia (a band of weak enamel, usually
>white and running along gumline) as a precursor to nursing pattern decay.
>
>On May 16th, Rita, you posted regarding her child who had anterior decay
>with a history of thrush being the difference between that and and her other
>three caries free children all of who were breastfed for 3 years.
>
>It is a possiblity that sugary oral medications may have been contributors.
>Teeth at the time of erruption are most suseptible to decay as they continue
>to mineralize and harden through bathing in salivary minerals in first
>months post-erruption. This is why sealants (if indicated) are best applied
>soon after erruption when teeth most vulnerable. Oral medications could be
>a risk factor, especially non-bacteriocidal ones. My third baby was on oral
>antibiotics from 5 mo. to 3 years. She had 3 weeks of IV antibiotics from
>age 9 days (suspected meningitis), heminephrectomy at 6 mo. ureteral
>reimplantation at 2 years. Never had a bottle, brfed through next pregnancy
>and tandem brfed briefly to 3 yrs. 3 mo. She has never had decay. In your
>case, Rita, besides providing a cariogenic food for bacteria, fungal
>medication, if used, could have affected the balance of oral flora and may
>have caused a strep mutans overgrowth (conjecture on my part).
>
>Will do my homework, and if I learn more will share with you all.
>
>Suzanne
>
>Mother of three cavity free children, and one with two samll molar pit
>fillings (to keep her dental hygienist mom humble and grateful that,
>perhaps thanks to breastfeeding, they are healthy in more important ways!
>
>------------------------------
>
>Date: Fri, 17 May 1996 14:09:04 -0400
>From: "Catherine Watson Genna, IBCLC" <[log in to unmask]>
>Subject: Re: LACTNET archives on the WWW
>
>"Ann Elsie"
>You make some interesting points. I have learned in life that anything we say
>or write to anyone has the potential of getting around in embarrassing ways.
>Therefore, I do my best not to say things I don't want repeated. This
>definately puts a crimp on the support function of Lactnet, if we are hurt by
>a colleague or institution we cannot cry to others about it without the risk
>of it getting back to that person. There were several times I started to post
>a whine and thought better of it...
> There is a definate upside to the web access to lactnet archives-
>other health professionals and interested parents could have access to some of
>the wonderful wisdom and information through this venue.
> Kathy and Kathy told us in the beginning to consider anything we
>posted as being on the cover of the NY Times....
>Catherine Watson GEnna, IBCLC NYC [log in to unmask]
>
>------------------------------
>
>Date: Fri, 17 May 1996 14:09:08 -0400
>From: "Catherine Watson Genna, IBCLC" <[log in to unmask]>
>Subject: Re: LACTNET Digest - 15 May 1996
>
>Suzanne,
> One important component of protection from dental caries via human
>milk is lactoferrin. Lactoferrin not only scavenges iron, making it
>unavailable for bacterial growth in the gut, it also interferes with bacterial
>carbohydrate metabolism. If strep mutans can't digest sugar in the mouth, it
>can't produce acid... Unfortunately, iron supplementation saturates
>lactoferrin and prevents it from doing it's job. The policy to supplement all
>children with iron fortified cereal or drops at 4-6 months in the US
>contributes to lactoferrin saturation. Also when solids are added to the
>infant diet, iron absorbtion from breastmilk declines. The recent Italian
>study of exclusively breastfed infants, though small, indicated that NO child
>who started solids after 7 months of age became anemic (followed through age
>24 mos.). So, our cultural practices (early solids and iron supplementation)
>are probably responsible for the amount of anemia and tooth decay we see.
>Iron supplementation is another factor to consider when attempting to tease
>out the relationship between breastfeeding, bottlefeeding, and dental caries.
>
>references:
>Bullen, JJ, Rogers, HJ, and Leigh, L: Iron-binding proteins in milk and
>resistance to Escherichia coli infection in infants, Br Med J 1:69-75,1972.
>
>Butte, NF, et al.: Macro- and trace mineral intakes of exclusively breast-fed
>infants, Am J Clin Nutr 45:42-47, 1987.
>
>Duncan, B. et al.: Iron and the exclusively beastfed infant from birth to six
>months, J Pediatr Gastroenterol Nutr 4:421-25, 1985
>
>Kirkpatrick, CH et al.: Inhibition of growth of Candida albicans by
>iron-unsaturated lactoferrin: relation to host defense mechanisms in chronic
>muscocutaneous candidiasis, J Infect Dis 124:539, 1971.
>
>Lawrence, Ruth, MD. Breastfeeding, A Guide for the Medical Profession, third
>edition, St. Louis, Mosby, 1989. p. 87, p.612-15.
>
>McMillan, JA , Landaw, SA, and Oski, FA: Iron sufficiency in breast-fed
>infants and the availability of iron from human milk, Pediatrics 58:686-92,
>1976.
>
>Mevissen-Verhage, EAE, et al.: Effect of iron on neonatal gut flora during the
>first three months of life, Eur J Clin Microbiol 4:273-78, 1985.
>
>Oski, F. and Landau, F. Inhibition of iron absorbtion from human milk by baby
>food. Am J Dis Child 1980; 134:459-60.
>
>Pastel, RA, Howanitz, PJ, and Oski, FA: Iron sufficiency with prolonged
>exclusive breast-feeding in Peruvian infants, Clin Pediatr 20:625-26, 1981.
>
>Piacane, A et al.: Iron status in breastfed infants, J Pediatr 127:429-431,
>1995.
>
>Woodruff, CW, Latham, C, and McDavid, S: Iron nutrition in the breast-fed
>infant, J Pediatr 90:36-38, 1977.
>
>Woodruff, C.W. The role of fresh cow's milk in iron deficiency. Am J Dis Child
>1971; 124:18.
>
>Catherine Watson Genna, IBCLC NYC [log in to unmask]
>
>------------------------------
>
>Date: Fri, 17 May 1996 14:09:10 -0400
>From: "Catherine Watson Genna, IBCLC" <[log in to unmask]>
>Subject: Re: retracted tongue
>
>Elizabeth,
>Sometimes babies position their tongues on their palates to stabilize the
>airway. Does this baby extend her head to breathe? Does she coordinate
>breathing with her suck and swallow?
>You might want to try having mom lean way back while she breastfeeds so the
>baby is almost prone. This can help airway stability and reduce the gulping,
>while giving gravitational assistance to tongue extension. Make sure baby
>approaches the breast tongue first, with her head very slightly extended.
>Often the football hold works well combined with the above interventions.
> If none of this works, baby should have some suck rehab or see an
>Occupational therapist, IMHO.
>Catherine Watson Genna, IBCLC NYC [log in to unmask]
>
>------------------------------
>
>Date: Fri, 17 May 1996 14:45:00 -0400
>From: "Nicholas M. Azzaretti" <[log in to unmask]>
>Subject: "Living on Earth" about BF
>
>In case you haven't heard:
>The National Public Radio environmental program "Living on Earth" this week
>is about breastfeeding. I heard the promo while driving home at lunch today
>- the topic is something about weighing risks and benefits of bf because of
>contaminants such as PCBs and dioxin. It's scheduled to air tonight (Friday)
>7PM in Maine, but apparently will be on at other days/times in other areas.
>
>Kate Pennington, LLLL, Newcastle, Maine
>
>------------------------------
>
>Date: Fri, 17 May 1996 15:00:27 -0400
>From: "L. Jonathan Kramer, P.E." <[log in to unmask]>
>Subject: Cutting silicone nipple shields and weaning from shields
>
>The silicone rubber used for nipple shields should be soft enough to snip
with a
>scissors, just like ordinary gum rubber was. My wife used the Med---
>shields for
>my sons first week or two. She was given them by the nursery nurse because
>my son's tongue couldn't come out far enough to cover his lower jaw. (This was
>1988 - now he'd probably have a frenotomy.) After a week or two, he was able
>to latch properly, and she just stopped using them. He apparrently never
>noticed
>the difference - just latched right on. Incidentally, he nursed until he
>was 4, and
>still asked for it for another year after my wife weaned him! He's never
>had any
>other problem with tongue-tie; he sticks his tongue out with gusto, and has no
>trouble with whistling or blowing bubbles with gum.
>
>Jonathan
>****************************************
>* L. Jonathan Kramer, P.E. *
>* Graduate Breastfeeding Counselor and *
>* Student Lactation Consultant *
>****************************************
>
>------------------------------
>
>Date: Fri, 17 May 1996 15:00:46 -0400
>From: "Digest Laurie Wheeler, Rnc, Mn, Ibclc" <[log in to unmask]>
>Subject: retracting tongue
>
>Elizabeth ,
>Re your baby with the retracting tongue: my gut feeling after reading your
>post was that this baby may have a minor birth injury (bruise, or overriding
>sutures, something) that makes him not want to open wide. The 90 degree angle
>of mouth is not open much, I like to see the angle very wide. Seems he may
>need to relax more so that he will open wide and bring tongue forward. What
>about bf in tub of warm water, very relaxing. Or even giving baby
>acetaminaphen or ibuprofen to see if helps. Also positioning where mom lies
>on her back, slightly propped up, and baby is laid down on top of her so
>tongue will come down more. Just a thought. Obviously, mom has very damaged
>nipples and so something is going on.
>The fact that he can milk the breast, gain wt, gulp, and be content post feed
>are great and I would not think indicate a neuro problem. I swear lots of
>times tincture of time works for these kinds.
>
>Hope you find some of this useful,
>Laurie Wheeler, rnc, mn, ibclc
>louisiana
>
>------------------------------
>
>Date: Fri, 17 May 1996 15:01:41 -0400
>From: "Nicholas M. Azzaretti" <[log in to unmask]>
>Subject: Living on Earth on WWW
>
>Quick follow-up to the Living on Earth announcement: they have a WWW site at
>
>http://www.npr.org/programs/loe/loe.html
>
>Among other items, they have a list of when & where to hear the program. I
>think it may be US only, but they do have tapes & transcripts avilable.
>
>Kate Pennington, Newcastle, Maine
>
>------------------------------
>
>Date: Fri, 17 May 1996 15:16:59 EDT
>From: "Melissa L. Brancho" <[log in to unmask]>
>Subject: WWW page
>
>Catherine,
>
>Are you concerned about the possibilities of interested parents causing
>themselves damage from accessing postings without proper supervision? For
>example (not to say this would happen): Mom has inverted nipples, learns
from a
>posting by "Fred" how use a syringe, doesn't want to pay for or seek out LC,
>tries it and really does harm to herself. Who will she sue? Fred? Lactnet?
>Of course I would hope this to be a one in a million shot but I am conerned
>about it. We encourage people to become more educated before helping moms but
>now we are going to give them access to information that they may end up
hurting
>them.
>
>I understood that Lactnet was for professionals in the field of lactation and
>others seeking personal support or help were referred elsewhere. Why the
>change? In my opinion, Lactnet will not be a professional forum any longer if
>it includes everyone. I don't want to get into any more heated debates.
>Believe me! But I haven't seen the postings about this and have lots of
>concerns on this issue. Anyone care to forward the original announcement
to me?
>It seems that this whole issue would be avoided if only postings that were
>published after this announcement were able to be accessed, sure seems like it
>would calm things down. Why is Lactnet doing this in the first place? What's
>the purpose?
>
>By the way, would posters be able to be sued for a parent who harms themselves
>using this information? I am not real familiar with these types of legalities.
>
>Melissa Brancho
>
>------------------------------
>
>Date: Fri, 17 May 1996 16:05:28 -0400
>From: Sarah Barnett <[log in to unmask]>
>Subject: jaundice
>
>There were several references about jaundice, including information from
>Dr. Lawrence Gartner, on Feb. 5 and 6th. I think that they would be
>helpful in any presentation to medical professionals.
>
>Sarah Friend Barnett, LLLL, IBCLC
>Bronx (New York City), New York
>[log in to unmask]
>
>------------------------------
>
>Date: Fri, 17 May 1996 16:31:50 -0400
>From: Sharon Coe IBCLC <[log in to unmask]>
>Subject: Re: Retracting Tongue
>
>Elizabeth,
>
>Although I mostly work with younger infants, I have had some luck with using
>the suck training techniques as taught by Chele Marmet for babies that hump
>up their tongue.
>
>Using the most appropriately sized finger (no long fingernails) , pad up I
>elicit a root and GENTLY introduce the finger along the palate so as not to
>gag the child. I slowly stroke back just a little on the hard palate then
>down on the tongue and usually within a minute or so the child learns to
>stick out his tongue more to suck on my finger. If possible I have EBM in an
>orodontal syringe to reward proper sucking action. The technique needs to be
>taught to the mother with a return demo so that she can remind the child when
>required. I stronly reinforce the need for mothers to follow-up at the WIC
>breastfeeding clinic as these women leave the hospital so soon after birth.
>
>Hope this helps,
>Sharon Coe LVN IBCLC
>
>------------------------------
>
>Date: Fri, 17 May 1996 13:53:37 -0700
>From: Deborah A Vandermey <[log in to unmask]>
>Subject: IBCLC exam
>
>I had a question from a collegue... How much will the exam incorporate
>new research into the answers? If the leading reference books state
>one thing, but new reasearch has found this information to be
>inaccurate, which will the exam answers be based on? If anyone
>knows I'd like to pass the information along. TIA - Debi VanderMey
>
>------------------------------
>
>Date: Fri, 17 May 1996 17:06:27 -0400
>From: Donna Norris <[log in to unmask]>
>Subject: insufficient milk supply
>
>I am presently working with a mother who has low milk production despite all
>efforts to improve it--She has been using a feeding tube device at her breast
>for 3 weeks, the baby is well positioned with a normal , nutritive suckle,
>and was approaching failure to thrive before we began the supplemental
>devise. Mother has also been pumping and can only produce about less than
>half of what baby needs in one day. Mother had normal breast changes in
>pregnancy, is 37 years old and reports 1 year of attempting pregnancy before
>succeeding. this is first pregnancy. She is on no medication. My question
>to the group is--If I want to do prolactin levels on her do I need to do a
>pre, during and post nursing levels? Should I even bother with prolactin
>levels since her baby is now close to 6 weeks old? I will try a course of
>reglan and check thyroid function tests.(She reports thyroiditis at age 7 or
>8) Anything else I might be missing? She and I are not ready to chalk this
>up to insufficient glandular tissue and bottlefeed!!!!! ( besides,it's rare
>to get a patient who is willing to go this far) Thanks, donna norris R.N.
>IBCLC
>
>------------------------------
>
>Date: Fri, 17 May 1996 18:00:38 -0500
>From: Patricia Gima <[log in to unmask]>
>Subject: dental caries/retracted tongue
>
>My first child had five cavaties by the time she was two years old (still
>b'feeding occasionally , though not throughout the night, just to go to
>sleep). It was discovered that she had incomplete enamel on all of her
>teeth, some visible as pale yellow areas. She saw a dentist every four
>months, had new cavaties each visit. We eliminated all refined sugars and
>brushed after her eating anything(I did the brushing.). She continued
>getting new cavaties in these primary teeth long after she was no longer
>b'feeding. Two pediatric dentists told me (26 years ago) that had she been
>injesting ABM she would have had even more serious dental problems. Her
>permanent teeth were perfect and she certainly took good care of them!
>
>I attribute her incomplete enamel problem to calcium deficiency during my
>pregnancy. I had a lot of leg cramps for which my ob recommended Benadryl
>to help me go to sleep(!) There could also have been an interference in
>calcium absorption at the time of calcification of the teeth(around 3 or 4
>months +, I think).
>
>In my second pregnancy, I added a calcium supplement and if I ever had leg
>cramps I increased my supplement and the cramps were relieved. Baby #2
>nursed much more at night than Baby#1 and for a much longer time and had
>perfect teeth.
>
>I recommend calcium/magnesium supplements to a mother who is nursing through
>a pregnancy, as a precaution.
>
>On the topic of retracted tongue, I have found that cup feeding for a day
>has brought the tongue out and down. The baby "wonders" what she was doing
>that made the breast go away and tries new ways when she returns to the
>breast. (Now this last part is a touch of projection.) I know you said she
>wasn't interested in alternative feeding methods, but persistent pain can
>spark interest in something once rejected. You might present it again.
>
>Pat Gima, IBCLC
>
>------------------------------
>
>End of LACTNET Digest - 17 May 1996 - Special issue
>***************************************************
>
>
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