As it is a tertiary centre we may have problems with critically ill baby on
multiple life support modalities in a bed - but mum possibly several hundred
miles away.
The reasons if mum is available may include mum not producing ANY milk due
to stress - and believe me this happens quite frequently. If she can even
'squeeze out' a drop we will be encouraging and use it if possible. Also
babies may not be able to tolerate enteral feeds and all calories and fluids
are given intra venously. This may be common after open heart surgery for
complex defects. On the whole these parents see BF as the least of their
worries [even those who have thymic dysplasia as part of a syndrome and who
could really use an immune boost!]. It is where I find problems with telling
parents formula can damage their kids. We take them, chill them to 22C, open
the sternum, return them full of tubes and wires, pour blood in the veins
and out of drains, pump them full of strong drugs, paralyse them, put them
on a ventilator.....I find that after all this the best I can do is put
forward benefits and encourage mums to express. Many don't.....
Similar fluid restrictions may apply in PICU for neuro patients / renal etc.
We have the will, we have the technology, we just don't always have a kid
who can tolerate any feeds....

If BF is chosen we have a milk kitchen to store EBM and it will be used. It
may be quite some time before this can be used if the child is slow to
recover BUT it will be used in preference to formula [especially important
as cyanotic children often have a diminished IQ and so need all the help
that can be given]. If not enough EBM is available then mixed feeding will
be used. I think that the 'supply and demand' analogy sometimes
disintegrates under stress.....
Further some mums can express enough to put down a tube when they are
present - but cannot build up a spare 'stock' to use when they go home for a
day or two to see siblings etc. [some of these kids can be critically
unstable for weeks].
I would be the first to admit that when the baby is able to self-breathe it
may not be possible to BF 'draught' as the child may still need oxygen or be
too tired to feed. Ultimately BF may fail as the child is unwilling to
suckle even when physically able. We use dummies [?pacifiers] to try to keep
children interested in sucking and to associate sucking with food being
given [via a tube] and hence that comfy full tummy feeling. Until we can
monitor the thoughts of a baby we have to believe in this psychology as it
is the best available. Comments and suggestions welcome!
At the end of the day we discharge home some kids who are a devil of a job
to feed. They miss that early part of the learning curve and it may take
months [?you can't teach an old baby new tricks] before mums report that
things get better. There are often problems introducing solids too.

Tony Knox
----- Original Message -----
From: "Katherine Dettwyler" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, June 26, 2001 7:13 PM
Subject: Tony -- can you clarify something in your intro?


> Tony, you write (and I'm editing out the middle part):
>
> >Since 1987 I have specialised in kids cardiac and critical
> >care. . . My students and colleagues think I am crazy for lecturing
>about
> >BF since most of our kids are not able to BF.
>
> Do you mean that the children you care for in the cardiac and critical
care
> nurseries are not able to breastfeed?  If this is what you meant, then
why?
> Why are they not able to breastfeed?  How are they being fed, and what are
> the reasons for it not being breast milk?
>
> Kathy Dettwyler
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