LACTNET Archives

Lactation Information and Discussion

LACTNET@COMMUNITY.LSOFT.COM

Options: Use Forum View

Use Monospaced Font
Show Text Part by Default
Show All Mail Headers

Message: [<< First] [< Prev] [Next >] [Last >>]
Topic: [<< First] [< Prev] [Next >] [Last >>]
Author: [<< First] [< Prev] [Next >] [Last >>]

Print Reply
Subject:
From:
Phyllis Adamson IBCLC <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 10 Apr 2010 13:50:32 -0700
Content-Type:
text/plain
Parts/Attachments:
text/plain (119 lines)
Christine:

You give an excellent summary of good practice. FYI: here is a link to the AAP update:
<http://aappolicy.aappublications.org/cgi/reprint/pediatrics;125/2/405.pdf>

I'm hoping that this update is sufficient for our insurance providers and hospital admin to adjust their practices.
Or do we have to go thru the legislature to change the state's medicaid law to specify these parameters as the Standard of Care that must be covered.

Phyllis

---- [log in to unmask] wrote:

=============
I am not sure what the intent was as I have not read the article.


However, my response would be:  "It is NOT normal for a child to be unable to breastfeed


therefore until the child has a diagnosis, he should not be discharged."  Then start listing


all the reasons there may be a problem:  sepsis, jaundice, delayed lactogenesis II, late preterm,


nipple problems, tongue-ties, short tongues, mandibular asymmetry, retracted chin. etc....




So for example, if the baby can't feed because of a tongue-tie then we need a feeding plan and assessment for


a nipple shield until it can be clipped.




Often the feeding plan will be to do some limited breastfeeding then pump and bottle-feed.  Mothers with short nipples and infants with


a short tongue are (in my experience) to be most at risk for bottle preference and I would firmly insist


that the mother be given the choice of how to supplement in this instance.  All mothers need a plan that supports infant growth while maintaining or


increasing maternal supply. I would try to obtain a DME request and coverage for an electric pump. She can even request Banked human milk to


supplement with although she will have to pay out of pocket. I have had mothers do this.




These mothers (who need to supplement) must be given very close follow up (1-2 days after discharge and then at least weekly)  to ensure


they succeed at breastfeeding.  And this should be part of the discharge plan for these dyads.


Since most pediatricians are not skilled in lactation this requires a referral to a lactation consultant.




This is an important policy as babies who are having problems breastfeeding are at high risk of re-hospitalization for jaundice and dehydration


which even further disrupts breastfeeding.




I am most bothered by the underlying message of bottle-feeding is the solution no matter


what the etiology.  It is representative of how poorly we have been educated in matters


concerning lactation.  I would also remind them that it is the mothers choice on how to supplement


and she should be given the options that are consistent with her child's needs.




Christine Betzold NP CLC MSN
www.theBFclinic.com
714-269-9879

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome

--
Phyllis Adamson, BA, IBCLC
Glendale, AZ.
[log in to unmask]

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome

ATOM RSS1 RSS2