Felicia has shared a distressing situation in her hospital regarding non-evidence-based breastfeeding practices. Here are some thoughts in no particular order: 1. As an IBCLC your practice and ethical guidelines require you to be able to assess breastfeeding. You can most certainly observe altered tongue function and document this in the record as it is within your scope of practice. Tongue-tie or ankyloglossia is a diagnosis. Altered tongue function is an observation. 2. Ordering a bottle of infant formula for all LGA, SGA, and infants with elevated bilirubin lacks evidence for this practice. You would need to ask for the evidence. It is also incumbent upon the hospital to inform patients of the side effects or hazards of any treatment--in this case the use of a bottle and infant formula. Are patients informed that a bottle has the potential to cause bradycardia during feedings? Are mothers informed that the use of infant formula alters the infant gut microbiome to one of inflammation and increases the risk for infection and autoimmune disease? If a mother is not informed of these risks, the potential exists for liability on the part of the hospital if the infant experiences diseases or conditions that can be attributed to gut dysregulation. Do the mothers sign a consent to supplement form with all of the risks declared? 3. You might wish to talk with your Risk Management Department relative to the hospital's liability in treating infants without parental consent and failure to advise regarding potential side effects of such treatment. 4. You could also speak with your Quality Improvement Department regarding the sub-optimal breastfeeding practices on your unit. Marsha Walker, RN, IBCLC Weston, MA *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome