The article I'm about to suggest is clearly beyond your question of exclusivitiy but this article has been helpful to many mothers I've worked with nursing or pumping for a child who cannot or will not accept table foods before 12 - 24 months.
Long-Term Breastfeeding: Nourishment or Nurturance?
http://jhl.sagepub.com/cgi/content/abstract/17/4/304
Many mothers are reassured about the importance of calories and nutrients from their own milk, even when table foods are a part of the diet. As to reassurance for HCPs, that is another matter.
As others have mentioned, many children, particularly those with sensitivities, refuse table foods until after a year, sometimes until 2 years. My understanding of the recommendations for solids after 6 months is that this age was chosen not because
"all children need supplement at this age" but that this marks the beginning of the time when table foods can be accepted, digested, and "do no harm." While the recommendation for additional nutrition is real, the recommended amount at this age is small. The blanket recommendation is meant to cover many situations, including those in which breastfeeding is less than complete and family resources are less than adequate. Each mother and child still deserve individual attention. I would be especially concerned about compromising the effect of a complete [human] milk diet on her immune system.
Again, as others have mentioned, it is surprising anyone would alter this child's nutition source while she continues to thrive and her dedicated mother's milk is abundant.
Anecdotally, my own daughter refused table foods until 14 months while remaining on the top of every chart and I have seen many toddlers refuse
table foods until 19-24 months while maintaining excellent growth and meeting every developmental marker. More often than not, children I have observed with this pattern are larger rather than smaller.
Ironically, there is plenty of evidence that prematurely weaning children from exclusive breastfeeding or exclusive ebm diets is detrimental but we don't "see" that as readily!
The studies requested may be a challenge though I would think someone on this list could point you to case studies. Perhaps the care for this child can be documented to help another child in the future. How old is this little girl now? Are her HCPs simply looking ahead down a long road or is an abrupt change about to happen? What changes might be expected based on swallow tests?
Perhaps a consult with another physician more familiar with the importance of human milk may be helpful, or the sharing of Jay's recent post (with permission).
I am quite impressed with the young mother and father of this baby. What a lucky little girl!
Susan Johnson MFA, IBCLC
Salt Lake City, USA
Thuwal, KSA
--- On Tue, 1/5/10, Aimee Crane
<[log in to unmask]> wrote:
From: Aimee Crane <[log in to unmask]>
Subject: [LACTNET] Length of Exclusive Breastfeeding
To: [log in to unmask]
Date: Tuesday,
January 5, 2010, 3:14 PM
I have been working with a mother whose baby was born with Cri-du-chat syndrome for some months now. The infant's epiglottis doesn't function (yet) so she receives all of her nutrition (to date, exclusively her mother's expressed breastmilk) through a tube which goes directly into her stomach through her abdomen. My question is this (from the mother): For how long can her baby receive nothing but her breastmilk? I know that 6 months of exclusive breastfeeding is recommended for all mothers, and that mothers who have food allergy issues (or their baby does) are sometimes recommended to continue to provide exclusively breastmilk up to one year, but for how much longer can a baby receive ONLY breastmilk? (I believe the mother is asking this question because her baby will have her next swallow study in a month or so, and she is already being pressured to supplement her breastmilk, and she wants to be
prepared with STUDIES to back her up as to the
safety of continuing to feed only her milk to her baby if the baby "fails" the swallow study (i.e., has to continue with this stomach tube.) FYI, this baby has grown BEAUTIFULLY (and continues to - the mother's milk supply is COPIOUS!) and exceeded all the doctors' expectations on virtually every developmental measure for a baby with her condition. This is the most dedicated young (20) mother and father, and I know in my heart her sweet daughter is doing so well in large part because the mother has been such a strong advocate for her and has consistently provided her milk for her notwithstanding virtually no support for breastfeeding from the physicians who have provided her care since she was diagnosed (with the notable exception of her wonderful pediatrician, Dr. Matt Irwin, who unfortunately doesn't have the lead in her care because of the rarity and severity of the health conditions
attached to this syndrome). So, we're looking for articles in
peer-reviewed journals that speak specifically to how long a child (over 12 months)can safely receive only breastmilk, and if at some point (presumptively), more something (calories/protein???) is needed, what specifically would that be and are there guidelines as to what quantities and when?
Thank you all in advance for your consideration. - Aimee Crane, IBCLC in Northern Virginia (Happy New Year to all those who work with breastfeeding families around the world!)
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