----- Original Message -----
From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, April 10, 2010 3:32 PM
Subject: New AAp Discharge Policy


>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
>
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