6/12/96

6/12/96
Dear All,

I have seen mold develop in pump tubing of all types not just PIS tubing both
because mother washed tubing and without any history of washing the tubing.
 I have seen condensation develop in tubing when mother pumps and this has a
lot to do with moisture content of ambient air--warm, humid air in summer or
increased humidity in winter from humidifiers in house, or just moisture from
mother's skin.  If moisture that develops from condensation when pumping is
allowed to evaporate by removing tubing from pump plus any filters and
allowed to air dry, I have not had problems with mold developing.  The same
is true if condensation is present due to inadvertent or deliberate washing
of tubes or filters.

Once mold is present, I feel more concerned and although I have received same
suggestion from Medela re drying tubing I have never felt comfortable with
this once mold is present and therefore in ALL instances where mold developed
I have replaced tubing--sometimes at no cost to mother; other times I charged
a fee.  Whether or not I charged a fee depended upon mother's financial
situation.  It is an area of concern which I believe needs to be addressed
and maybe those of you who are going to ILCA conference can discuss this with
pump reps in person.  Unfortunately, I can not afford to attend this year. :(


In the past month or so an article appeared in the Washington Post Health
section ( a weekly insert devoted to health issues).  This article primarily
focused on recent research that indicates that premies can be fed by mouth
sooner than previously thought and that they benefit from these earlier by
mouth feedings.  Toward the end of the article a brief mention was made that
research was suggesting that infants can tolerate solid foods earlier than
once thought and that many doctors were now suggesting solids as early as 2-3
months pp.  Even though the primary focus of the article was on premies, the
only picture shown (a large one) was of an infant being fed baby food from a
jar.

I have been working with a mother-baby dyad recently.  Baby had tight
frenulum and has since had frenotomy.  Mother has limited support from family
to pursue breastfeeding and her PD is rather ambivalent in his support of
breastfeeding so mother has declined to see me again for consult re getting
baby to breast.  Day before yesterday, she purchased a Medela Pump in Style
breast pump from me and returned the Lactina pump she had been renting.  At
present, she is able to provide about 1/2 of her baby's milk needs but she is
not pumping as often as I have suggested.

Anyway, on the day she purchased PIS pump she told me that PD had suggested
she begin adding cereal to baby's formula when baby turned 6-8 weeks of age.
 I informed her of why I disagreed with this advice.  Are others of you
seeing early intro of solids being advised in your community?  Has AAP
changed its recommendation re intro of solids?

Today this mother called to ask advice about her baby because baby is colicky
and not tolerating Nutramogen well.  I suggested following for consideration:

1) consider soy formula use for short term
2) contact local milk bank for human milk to supplement baby (explained why
this was better option than #1 but I know she first has to get M.D. approval
for banked milk and soy formula may be baby's best choice in short term)
3) increase frequency of pumping to increase milk production and consider use
of metaclopramide for increasing milk production.
4) seriously consider follow-up with me to attempt baby's return to breast
and other measures to attempt increase in milk production
5) eliminate all milk-containing foods from her diet (mother was intolerant
of milk as infant and grandmother reports she switched from one formula to
another but mother's behavior did not improve until she switched her to whole
cow's milk at 3 months of age.  Great imput to encourage mother and support
breastfeeding, right?  NOT!)
6) colic is multi-factoral syndrome and cause can not always be determined
but since Nutramogen is pre-digested cow's milk and she has history of cow's
milk intolerance, use of ABM is likely culprit.  Baby had already had
problems with Enfamil and was switched to Nutramogen by PD.
7) can't spoil baby by holding and comforting even though all your measures
may not stop baby's crying.
8) stressed benefits of breastfeeding (#1) or breastmilk-feeding (#2) over
ABM of any kind.
9) stressed that this was all the more reason to delay intro of solids to her
baby
10) urged her to follow her heart rather than listening to others who are
advising her to quit attempts to breastfeed or provide breastmilk for her
baby.

Thanks for listening and for any input re early intro of solids in your
community or anything else I have written.

Going to my niece's HS graduation tomorrow .  Will return 6/15 and retrieve
my mail at that time.

Anna Utter, BS, IBCLC
Lactation Resources
Community-Based LC private practice
Gaithersburg, MD
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