Karleen's suggestion is a good one and perhaps if a piece of plastic wrap  
was put inside the shield to cover the holes of the shield and the tubing put on 
 the outside of the shield then baby could be at breast but get the 
supplement  instead of mom's milk.  Would this work?  How sad for baby and  mom.
 
Barbara Latterner, BSN, RN, IBCLC
________________________________________________________________
 
Many women who are trying to wean babies back to teh breast (adoptive  
mothers, relactation, cleft babies) use a set up where a breastfeeding  
supplementer is threaded through a nipple shield or bottle teat and held  
over the nipple so the baby feeds at the breast while getting milk from the  
supplementer. In such circumstances some milk comes through the shield but  
maybe none through the teat and maybe there are ways to have a "blind"  
nipple shield so this baby can still "breastfeed" but not get milk (can  
someone think of a way to do this!). I really feel for this poor mum and  
bub.
Karleen Gribble
Australia

----- Original Message -----  
From: <[log in to unmask]>
To:  <[log in to unmask]>
Sent: Thursday, February 14, 2008 2:51  PM
Subject: Leucine catabolism - followup


> My questions are  moot now. Because baby's labs show he is still acidotic, 
> the order is  to completely stop breastfeeding. He was getting too much 
> protein. So  they are still trying multiple nipples, still using the NG 
> tube, and  still trying to create a formula he can tolerate and that will 
> properly  treat his metabolic acidosis.
>
> He was diagnosed at least 3 months  ago and was put on I-Valex-1 then, but 
> he fought the feeds so hard, mom  always ended up breastfeeding. He has 
> been hospitalized before this  (2-3 times I think) for acidosis because mom 
> has been unable to get  baby to take the special formula.
>
> He's over 14 lbs and fights  the bottle and the formula really hard. I 
> suppose she could hog-tie  baby, but how do you hold his head still and 
> make him swallow something  that makes him gag? This is not an approved 
> parenting practice! Yes, I  know that.
>
> Latest formula is a mixture of I-Valex-1 plus ProFree  plus Similac.
>
> So I recommended a referral for social / emotional  support for mother as 
> she deals with this loss and with baby's constant  crying and tugging at 
> her clothing. The doc will write for this, but I  don't think the doc 
> realizes how profoundly sad this mother is now - as  is her baby. When I 
> saw her today, she looked stricken but stoic. When  I told her how sorry I 
> am for her loss of this special relationship,  she cried. I may be the 
> first, but hopefully not the only one, to  acknowledge the pain of this 
> necessary life change.
>
> And  I suggested contact with her WIC office for an effective pump and 
>  proper pump-down instructions, and time with a peer counselor to work thru 
 
> her grief and her loss. She gave me permission to call her WIC office  for 
> her to assure that she can get a pump and competent  help.
>
> My next question for the doc is whether they could send  baby home with the 
> NG tube for these feeds and follow up with Home  Health visits. Maybe, with 
> time, he can learn to accept the bottle, but  he needs close monitoring of 
> the NG tube until that time. I'd think a  Home Health visit would be 
> cheaper for the System than another day in  the hospital. Is this a 
> reasonable proposal?
>
> Come to  think of it: I don't recall seeing a pacifier - mom was his 
> pacifier.  There's another challenge: to teach a 5 1/2 mo old baby to take 
> a paci  while receiving NG feeds. I know they do it for NICU babies to stir 
> up  digestive juices and attempt to meet sucking needs, but this is a 
>  different ball game.
>
> Welcome all suggestions or  thoughts.
>
> Phyllis
>
>  --




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