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Subject:
From:
"Marie Davis, Rn, Clc" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 5 Sep 1998 18:33:42 EDT
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Friends,
I want to share this case with you because the information I gave the parents
led to quick action on their part, not to pat myself on the back (so to
speak).  Maybe I should have titled this case the power of education.

History: This mom is a great success story.  Did not nurse or pump for 8 days,
went through really bad engorgement that subsided and felt she had basically
*dried up*.  When they came to Great Starts she told me she really wanted to
breastfeed but they could never get the baby to latch on (he got bottles
first).  Went through the nipple shield/pumping/fenugreek route.  After 2
weeks she was over supplied and baby was nursing beautifully!
At an office visit last Friday for a final weight check, I watched him
peacefully nurse and turn into a screaming maniac after burping.  I asked
questions about other fussy behavior.  What they began to describe set off a
bunch of red flags:  He screams when we hold him, when we lay him down, after
he burps and we can only get him to sleep in the car seat.
I suspected  reflux immediately.  I  explained that reflux it is a common
problem that causes heartburn and post feeding fussiness.  I told them reflux
can have more serious effects (I remember saying something specifically about
burning the esophagus from stomach acid).  I also told them that in most case
treatment is simple, trying to reassure them.
I sent the baby over to the pediatrician right away.  Thank goodness it was
one that I have worked with a lot and *trusts* my judgement.  By the time he
got there, he was very calm but the pediatrician checked him over and told the
parents if anything *odd* happens bring him right in.
Sunday he began vomiting large amounts of bright red blood with clots.  His
stool was now tarry black.  ER told mom it was her blood from her nipples and
not to worry: just stop nursing.  This (very smart) mom promptly pulled out
her breastpump, pumped, handed the doctor the bottle of milk and told him to
check the milk for blood.  There wasn't any.  Then the parents related my
suspicion of reflux  and the ped's warning just 2 days earlier.
Enter every specialist in the world.
Baby has a suspected erosion through the lower end of the esophagus.  Has
received 2 blood transfusions and appears to be doing better.  He is scheduled
for an endoscope on Monday because they had to wait for the barium to clear.
(They did the upper GI first).  Stool is still positive for blood but no more
vomiting.
From Sunday through Friday the GI doctor had the baby on clear fluids only:
pedilyte.  Mom was told no breastmilk because they feared  blood from her
nipples might make the stool test positive for blood.  With encouragement from
me that breastmilk is a clear fluid, mom (on her own) suggested this
compromise to the doctors: what if I pump, you test the milk for blood and if
there is none, we can  feed it to the baby.  (effectively eliminating possible
bleeding nipples as a cause for blood in the stool).  It worked.  Baby is
getting the pumped milk he needs so badly.
We might have to start at day one with getting baby back to the breast after
this is over, but getting this diagnosed and fixed now is more important.
After everything this mom has been through she wasn't going to give up on
breastfeeding.  She was empowered, by information/education to take an active
role in her child's care.  Because of that empowerment she got the ER doc to
listen and probably saved her baby's life.
Friday she sought me out at the hospital to ask if I could do something to
help her roommate who was having breastfeeding problems.  I was absolutely
stunned.  Imagine, thinking of someone else when all of this is going on in
her life.
I vote for a medal of valor for this mom.  How about you?
Marien Davis, RN, IBCLC

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