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Subject:
From:
"Barbara Wilson-Clay, Ibclc" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 3 Jan 1996 08:34:07 -0500
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Denise.  I'm glad baby is receiving more evaluation.  I think it must be a
bit tricky to eval. the extent of some heart defects.  I've seen several
babies of this type, and often their energy level is the pits -- way too low
to expect baby to be able to sustain itself with normal bfg. They need lots
of help, and in my opinion, the emphasis should be on helping baby gain
enough weight to best tolerate surgery asap so the crisis can be resolved and
parents and child get on with normal situation.  I have worked with feeding
tubes and bottles with such kids, and occasionally these aren't even
efficient enough and child must be gavaged.  Having seen one such case, I can
warn you that if baby is not ever put to breast or given a pacifier to suck
(to maintain happy mouth exper) they can get very aversive to any kind of
oral feeds. I saw  such a baby with repairable heart defect whose first
symptoms were lethergy at breast and very swg.  I referred to pedi, he sent
to cardiol. and goal was to get baby up to a certain wt. for surgery.  Baby
couldn't get sufficient intake even from feeding tube or bottles.Gavages
begun.  Cardiol. nor hospt. staff mentioned letting baby have pacifier or
'dry sucking' at breast.  In fact, this was discouraged as it might use up
calories. I disagreed, but was over-ruled.  This is not an "I told you so"
that I gleefully insert, because results were a nightmare.  Baby wound up
being gavaged for a year and it took a PT a lot of therapy to get anything in
the child's mouth.  Baby freaked when anyone came near her, and parents had
fragile child syndrome:  feared absolutely that stress would harm her and
backed off on moving her away from the very thing that (tho familiar)  was
givng her oral aversion (ie gavages) for fear she'd starve from refusing to
eat.  Very complicated.

The good news is that mother pumped for 12 months, and no matter how milk was
delivered, it was breast milk.  Child recovered well physically and has been
healthy.  she is 2.5 now, and when I saw her the other day seemed small but
normal.  Parents shared story of pumping with L-----a in all sorts of odd
places:  airports etc.  Dad holding up a coat to give as much privacy as
possible.  It was a heroic effort that they feel good about now, but mom gave
cardio. and hospt. nicu staff a good talking to about how some of their
difficulties could have been avoided by allowing baby to get to actually suck
in her early days.  You know, I think that getting baby to breast or to suck
may be one of those developmental things like Lawrence ref. when she
discusses that babes need to begin to eat during a certain time period  or
they may miss a develp. window and have more feeding problems with solids
when introduced later.  Now some babies aren't ready and learn to eat fine
later, but putting things in their mouths (which they all do as soon as they
can) prob. serves the same purpose.  This is why I think it is so impt. to
get babies to breast rather than think that cup or finger feeding is anything
more than just a way to keep babies alive.

Barbara Wilson-Clay, BSE, IBCLC
Austin, Tx  priv. pract.

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