Magda, Great letter. I think the authors are missing the point. Here's what
I wrote them:
This paper leads one to believe that breastfeeding somehow can cause
hypernatremic dehydration and so requiring breastfed babies to be watched.
This seems to miss the point that babies who become dehydrated and
hypernatremic are really not breastfeeding, so breastfeeding needs to be
watched. More to the point, these babies are not breastfeeding EFFECTIVELY.
It is possible too that a mother may have insufficient milk for any number
of reasons. So the problem does not lie with breastfeeding, but with lack of
effective feeding. This could mean not breastfeeding often enough or not
extracting milk well with each breastfeeding, however frequent. This needs
to be assessed very early by a skilled breastfeeding observer/helper. And of
course taught and shown to the parents who continue to assess
breastfeeding's course over the next few days.
Many healthcare providers are not skilled in assessing breastfeeding.
Believe me, I have had many mothers of new babies tell me that they reported
no stooling to their pediatrician, only to be told to give the baby a
suppository. This will not nourish the baby!
I would be willing to guess that on the day of birth or certainly by 3 or 4
days after birth with the babies studied, this ineffective breastfeeding was
quite evident. In my opinion, the cardinal signs are low volume of urine and
stool, no "milk stools" by 4th day, and jaundice. Lack of breast fullness in
the mother after a few days is also a "red flag." It is imperative that
corrective measures to optimize the breastfeeding, the milk supply, and the
infant's intake be undertaken at this early stage.
Laurie Wheeler, IBCLC, MN, RN
Violet Louisiana, s.e. USA
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