I find that many babies with Down's syndrome have low tone, even the healthy babies, and often benefit from some additional breast milk at first. 



We have incorporated more hand expression at our hospital and moving away from pumping for some of the patients especially on the first day. This was decided based on the studies by Dr. Jane Morton at Stanford University Hospital showing hand expression to be more effective at removing colostrum. I went to a seminar recently, by the way, where I heard someone speak from your organization and it was wonderful! Thank you for all the good information. 



Generally, we have been having the mothers with healthy babies in their rooms that are not latching or feeding poorly, just hand expressing in the first 24 to 36 hours and then set up a pump after that if we need to. We are setting up a lot less pumps which is great. It's also less set up and clean up and less disruptive of sleep in the middle of the night. Many babies start feeding better by 24 hours and pumping is not needed. But milk expression also depends on the mother though. Because some women won't touch their own breasts, or have carpal tunnel syndrome. If we see that the mother is hand expressing a huge volume on the first day and she wants to try, we might set up a pump sooner. So these are guidelines but you have to take into account the individual woman as well and her situation. Sometimes women like the hand expression so much they don't want to pump until they have signs of mature milk production. We start pumping sooner if they refuse or can't do HE. 



If the baby is very sick and transferred to the Nursery or NICU, then we start with hand expression in the first hour and a combination of 15 minutes of pumping followed by about 10 minutes of hand expression. We recommend trying to aim for x 8 sessions in a 24 hour day, about every 2 hours during the day and 4 hours at night. We also use a pair of peri-pants or abdominal binder to make a pumping bra for them so they can do hands-on pumping. We saw our milk volumes jump up when we went to hand expression. 



I find that there is nothing wrong with just erring on the side of caution with a baby with Down's syndrome and giving a little extra colostrum after each breastfeeding and mothers often have a nice bolus of colostrum after delivery. So we recommend it for all the babies with Down's syndrome that they directly breastfeed and then either before or after the feeding receive some additional colostrum. I like Jane Morton's method of spoon feeding colostrum to the baby after each breastfeed. 



I like to tell the mothers that pumping is sort of like doing the dishes. If you have a dishwasher it can be a great convenience to help you. But sometimes doing them by hand gets your dishes cleaner and works just as well. They seem relate to that analogy. I hope this helps you. 



Tricia Shamblin, RN, IBCLC

Froedtert Hospital 

Milwaukee, WI





Date:    Thu, 22 Mar 2018 14:31:05 -0400

From:    Julia's Way <[log in to unmask]>

Subject: How soon to start pumping?



Hello, I am working on materials for our non-profit to promote breastfeeding among mothers of babies with Down syndrome and am attempting to get a definitive answer to "how soon should you start pumping?!" (or hand expressing, which we are also strongly encouraging mothers to do in the first 24-48 hours). I have looked through the archives extensively and haven't found a helpful answer. This mostly for babies that cannot breastfeed due to various issues or they are not able to stay with their mothers because they are in the NICU.



Thank you for your help!

Ella



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Ella Gray Cullen

Founder and Executive Director, Julia's Way *www.juliasway.org <http://www.juliasway.org> * Facebook <http://www.facebook.com/juliasway2016> | Twitter <http://www.twitter.com/juliasway16> | Instagram <http://www.instagram.com/juliasway16>



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