On the other hand - let's absolutely pragmatically think a little bit 
outside the "just milk supply" box.

On 7/31/2014 4:19 AM, Carmela Baeza wrote:
> At home, she has a three year old child with autism. She and her husband have very little support from family and friends, because the mom is terrified of her baby gettiing any kind of infection - she does not let anyone help her with the older child so as not to expose him to germs that he then might pass on to her and she to her hospitalized baby.
>
> So she and har husband are taking 12 hours turns, in which one of them is at home with the older child and the other is at the hospital with baby. Of course, the older child is reacting strongly to the whole situation.

1. First and the most important.
While understanding her intrinsic fears, the number one recommendation 
to this family (breastfeeding or not, BTW) will be to review the 
airplane safety card


/*
*//*TAKE CARE OF YOURSELF BEFORE HELPING OTHERS*//*(just in case of 
problems with formatting - this phrase was bolded and italicized).
*/If (unfortunately - more probably "when" then 'if") any member of this 
family (mother, father and/or the older kid) will crash - how that will 
help the sick 1 mo old?
The art of any parenting (and especially of parenting in extreme 
conditions, like we have here) is the art of being selfish. Priorities 
have to be set and the short and long term plan of action should be 
devised understanding that the present arrangements are self destructive 
and not effective.
It is easier said then done. But somebody has to talk to the FAMILY (not 
just mother) and LC involved is in a great position to do so. Most 
probably this "supressed/very delayed letdown reflex" is the very first 
but not the last/worst complication of the present situation.

2. Infection control. Stress, sleep deprivation, suboptimal nutrition 
and physical fatigue are the predisposing factors for significantly 
reducing the immunological defense mechanisms.
Even more, with all the therapies the older kid is most probably 
getting, the seclusion is relative anyhow. If they do have anyone who 
would be able to move in with them - that would be great, otherwise 
hiring a live-in (or at least a part time help) may be a very important 
part of the survival plan for this family. Flu vaccination is definitely 
highly recommended, as well as TdaP for all adults.

3. As a first step in deriving the survival plan I usually recommend to 
have a walk through the house to determine what can/should be done 
without parent's involvement - cleaning, cooking, laundry, shopping, 
mowing, etc. Then assigning everyone who wants to help into the support 
network. Some people can cook and bring food to their house. Some people 
can chip in-to paying for the live-in or for the cleaning service, or 
doing shopping or something else.

4. Sleep is essential. Without sleep parents would not be able to 
function and survive. Two extremely fragile kids do depend on their 
sanity. Therefore if they are planning to have 12 hour shifts, they have 
to find as many opportunities to carve out time for at least 8 hours of 
sleep per day. Not necessarily in one sitting (or laying for this matter 
;D), but as an aggregate. Power naps are essential. I.e. rather then 
driving to and from the hospital consider using the reliable designated 
drivers (see #3 above), thus having the commute time for so much needed 
time.

5. The situation with either of their kids would not get better 
overnight, tomorrow or next week. They are here in a long run. 
Scheduling time for themselves (even a lunch date) at least weekly will 
be extremely beneficial. By "scheduling" I mean - arranging care for 
both kids and making sure that NOTHING will interfere with these 
arrangements.

And while making all those changes - mother definitely can use all the 
great advises that people are posting here.

Hope that helps.

Alla/*

*/

-- 
Alla Gordina, MD, IBCLC, FAAP
General Pediatrics
Breastfeeding Medicine
Adoption and Foster Care Medicine

Global Pediatrics and Family Medicine
NJ Breastfeeding Medicine Educational Initiative


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