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Subject:
From:
Christine Staricka <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 9 Oct 2011 23:23:03 -0400
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Ah, Liz, you have really gotten to the heart of the matter (as usual.)  This is a topic near and dear to my heart, as well as to my daily work.  Perhaps what we need are some quotation marks around the name "Human Milk Fortifier."  After all, who coined that term?  I'm guessing that a formula company is responsible for that.
  
When I explain why we are using "fortifier" to the parents in our NICU, I stress the need for <additional, extra, more> vitamins and minerals for a temporary period of time due to baby's <prematurity, IUGR/SGA status, specific need identified by physician.>  When it is discussed during Multidisciplinary Rounds, I gently remind the group that it is being used to complement mother's own milk, NOT to increase weight gain (as is often implied by others in attendance.) Of course, sometimes weight gain is a consequence of adding "fortifier" to mother's own milk.  The "need" or suggestion to use "fortifier" is often met with confusion by parents.  Particularly when parents come away with the impression that increased or faster weight gain is a desirable goal is the problem exacerbated; U.S. culture in particular is confused enough as to the desirability of rapid weight gain in infants.  

When "fortifier" is used in a situation where mother's own milk is not analyzed for actual nutritional content, we are only guessing as to what the baby is being fed.  We are estimating, using some averaged, non-specific, standardized information as to how much fat, protein, etc are in this mother's milk, and then adding a set number of elements to bring it up to a level which has been recommended by someone hopefully closely involved in the baby's care. 

In communities with less sophisticated post-NICU followup care, there can be mass confusion as to the use of "fortifier" or even the use of higher-calorie formula for indeterminate periods of time.  If no one ever tells the parents they can stop using it, how will they know?!

Like nipple shields, "human milk fortifier" is designed to be used as a temporary tool to overcome a specific situation, and a predicted outcome and estimated timeframe should be provided to parents when it is introduced.  

I'd love to hear some suggestions for other terms we could use to describe this product.  

Christine Staricka, IBCLC, CCE

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