I had a little run-in with our renal attending physician last week.  A baby
was admitted from the Middle East with extreme malnutrition and
congenital kidney disease for a genetic and metabolic work-up.  She
was 6 months old, breastfeeding and bottle feeding formula and weighed
less than her birth weight.

The speech pathologist was consulted to assess feeding skills and she
suggested that they contact me to evaluate effective breastfeeding.  The
renal dietitian also suggested a lactation consult.  When I went to see the
mother and baby, I noticed a note in the medical chart from the attending
physician stating that the mother badly wants to nurse the baby, but that
this should not be allowed.  So I approached him and asked why he
didn't want the mother to nurse the baby.  He replied "Well, of course
there's no milk there or else the baby wouldn't be so malnourished."
Then he said, "It's the need of the mother to breastfeed the baby. The
baby does not need to nurse."

I couldn't believe he said that!  First of all, it IS the need of the mother to
be close to her baby and what's wrong with that anyway!!  This mother
has every right to breastfeed her baby.  And besides, how does he
know that the baby doesn't benefit from the comfort of breastfeeding as
well as the immunologic properties of the breastmilk.

In any case, the mother (who doesn't speak much English) with support
from the nurses (who somehow missed the orders against
breastfeeding) continued to breastfeed her baby several times a day
while hospitalized.  The baby gained some weight on 16-20 ounces of
concentrated formula a day, and a test weight on one breast showed
that the baby received an ounce of breastmilk in less than five minutes,
so I know she's getting some of her mother's milk.

I told the mother to continue breastfeeding as long as she and the baby
want to (which is exactly what she planned to do) with formula
supplementation.   I don't think this physician likes me very much.  My job
can be extremely frustrating.

Rachelle Lessen, RD, IBCLC
Children's Hospital of Philadelphia