Gonneke says,

<< Offering sugar as relief can dispose the child to seeking sweets for relief
 in the rest of its life, and then causing obesity, dental damage, diabetic
 diseases.
 I would advise against using any types of isolated or others sugars for as
long
 as possible in a child's diet and definitely against the use for
non-nutritive
 purposes. Offering the breast to suckle will provide lactose (sugar in a
 non-isolated form) and deep-satisfying sucking. >>

While I understand the thrust of this post, and agree that giving a
baby/child a lollipop after you have given him/her an injection MAY
predispose this person to the type of behavior you are suggesting -- I think
what we are discussing here is the use of sucrose during a painful procedure
in a newborn, i.e. circumcision.  I don't think that offering a sucrose
dipped gauze or in a nipple as Peggy's study suggested is anymore predispose
this baby to obesity than giving a baby a little bit of wine during the
circumcision in a ritual bris turns said child into an alcoholic.

And I think we may all be missing the point.  I think Peggy's study is
wonderful, and not to be dismissed.  While breastfeeding during/after a
painful procedure is certainly to be something to consider, I would imagine
it is extremely difficult for the mother to breastfeed effectively DURING the
circumcision.  In our facility, many of our babies are circed before they
have breastfed well one or two times, let alone breastfed well enough to know
that the breast is a source of comfort.  Many don't nurse after the circ for
several hours.  Most of our OBs do NOT do a dorsal block.  I don't want to
get into a discussion of the value/no value of a circumcision or whether or
not the OBs SHOULD do a block -- what I am saying is that we need to pay
attention to the study that Peggy has shared with us, and figure out if this
is something we can do in our facility for our baby boys DURING the painful
procedure.  And then get them back to mom ASAP to nurse and or snuggle or
whatever.  I think it is important to remember that babies get disorganized
easily from crying, and it is hard for them to regroup and then begin
suckling effectively.  So I'm all for doing whatever is going to make life a
bit less painful for them.

On another topic -- that of when to start pumping if baby has not gone to
breast and breastfed effectively.  First off, if the baby has gone to the
NICU, I think mom needs to start pumping (and please don't get onto hand
expression -- I don't want to go there at this point) within 6 to 8 hours
after birth.  I'm finding that it often takes from 5 to 7 pumpings for the
pump to produce anything, and I don't want to postpone getting something for
the baby any longer than necessary.  For the baby who is not latching on and
breastfeeding, but is with mom, I suggest lots of skin to skin, snuggling and
cuddling -- etc etc, BUT I also think that pumping needs to be started well
before 24 hours.  I'm not sure of the scientific rationale of waiting 24 to
48 hours before initiating pumping, but that is NOT how I read ILCA's
recommendation.  I don't think it is suggesting to wait for 24 hours -- but
that could be in my interpretation.  I do think it is important to get things
going.  Babies glycogen stores are depleted by 12 hours (see reference # 76
in Evidence Based Guidelines), and frankly, I think babies need food.  I'm
not enthusiastic about not feeding a baby just because it hasn't been 24
hours yet and he hasn't nursed, nor do I believe it is in the baby's best
interest.  If some colostrum can be hand expressed into a spoon and fed that
way, wonderful -- but again, I'm seeing that moms aren't getting anything
with the pump for 5 to 7 pumpings, so do we really want to wait 24 hours and
THEN begin the pumping process?  What are we going to feed the baby in the
meantime?

While I would like to think that all babies will latch on if we just give
them enough time, I'm also realistic enough to see what is going on in terms
of hospital interventions.  Moms WANT their babies to eat, and if we can get
them pumping while baby is figuring out the latch process, they will feel
better.

A nickel's worth in Wheaton,
Jan

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