In light of the thread re: BF during illness, I would like to share 2
consultations in my practice. The first was about 9 years ago seen in
conjunction with Kittie Frantz (We should have published this formally
and now cannot locate the case to do so - mea culpa). It was an 8 w.o.
who had a good wt gain at 2 weeks but now I saw because mom's milk had
"dried up." A Hispanic mom, she believed "no milk" because he had
started to nurse every hr for 10 min, then would cry. She'd tried some
Mexican brand of ABM, but he promptly became deathly ill vomiting, so
mom (wisely) returned to every hr BF. Now he weighed the same as his 2
week check (lost weight) and had an uncoordinated suck. He also had a
terrible cold - nose and chest with cough for which the ER doc had
prescribed 3 wks of erythromycin. I basically taught mom to increase her
own fluids (rule of thumb: drink so much, mom has to pee every 2 hours)
and then taught her BFing for a hypotonic baby (like with Downs). I
insisted she followup with Kittie. Eight days later, he'd gained 11
ounces (!) but had lost function in many of his cranial nerves,
including suck/swallow. Diagnosis? Pertussis (whooping cough) right here
in downtown Los Angeles. The problem with Pertussis is that it causes
neurological damage. The infant mortality rate for pertussis *under 1
year* is 70%. Nobody believed this 8 weeker would live. We told mom to
keep BFing as long as possible. The happy ending: He survived; his cough
lasted 8 months; he had significant cranial nerve damage (considered
"permanent") by 3 months which "faded" gradually over 1 year; he was BF
well into his second year; by entry to kindergarten, he had *NO*
neurological sequelae!! None!!

Another case of mine was an infant who, after a difficult delivery,
received 25 minutes of CPR before taking a gasping breath, had seizures
and received the prognosis of severe anoxic brain injury (was actually
declared brain dead upon arrival in the NICU), but rallied after a 10
day stay to go home actively nursing, then thrived on BM. Mom had
intended to BF for 6 months, but after my info and encouragement, BF for
2.5 years - he is bright, active, advanced developmentally and
intellectually for age - no sequelae.

I believe both of these excellent outcomes happened because human BM
lipase is specific to neuro development and myelination at which level
formula cannot imitate. There are no good studies for this that I am
aware of. We know (good studies, replicated many times for 100 years -
the first study done by Anna Freud) that BF babies "on the average score
8 IQ points higher than ABM babies." Much speculation surrounds why this
is so. IMHO, it is a combination of factors, including but not limited
to time spent being held, switching off sides (stimulates alternate
sides of the body, face, and eyes), as well as the composition of milk
itself. Who cares about 8 IQ points if your baby inherits an IQ
potential of 120? But what if your baby inherits an IQ potential of 92?
or 80? Or experiences "insult" or damage that reduces a good potential?
I would be outraged as a mother to discover too late that the medical
establishment knew of something that "might" help that I could do myself
but didn't tell me about. I now inform moms of this aspect of BM
whenever I work with a babe who may have a "neurological insult" (what a
euphamism!) so mom can make a truly informed decision - ABM decisions
convert to BF and BFers decide to nurse longer. Everyone benefits.

I find this very exciting and just wanted to share.

Katharine West, BSN, MPH, FNP in-training
Sherman Oaks, CA