1. Last I heard, the AAP considered breastmilk to be a "clear fluid".
Personal experience here: DS2 was diagnosed with RSV at 10wks. At hospital, I was
told "no formula". When I told them he was exclusively breastfed, they showed
me a trifold that shows what to feeds infants with RSV. Formula-fed infants
get IV fluids only until congestion clears, exclusively breastfed infants
continue to nurse because the AAP says it's a clear fluid, and won't hurt the
congestion. I don't have that trifold anymore, though. Maybe we can find the AAP
reference that says it's a clear fluid and show this doc. I won't have time
to search until naptime, later today.
2. Did he see Dr. Hale's book? Or did mother just tell him about it? He
needs to *see* a copy of the book, and other recommendations that his book is
good info.
3. Suggestions: normal stuff to increase baby's milk intake. Sleep in same
room, so baby can nurse more at night. Pump and nurse at same time to take
advantage of letdown. Suggest breast compressions during pumping to increase
amount pumped. When pumping, wait for second or third letdown. Make sure
flanges on pump fit correctly. You didn't mention which pump she's been using
(before trying the Whisper Wear), but make sure she's using a quality pump. Maybe
put her on a rental for a month to help her supply.
That's all I can think of so early in the morning, before I've had my coffee.
I'm sure others will have more info.
Shannon Rittenhouse
Sterling, VA
In a message dated 10/12/2005 9:29:16 PM Eastern Daylight Time,
[log in to unmask] writes:
1. Mother takes baby to ER, diagnosis Bronchitis. Baby is one week shy of
one year of age. The physician states I can't believe you are still
breastfeeding! In the instructions to the mother is clear liquids,
absolutely no breastfeeding! He even circled it and had the nurse restate
it for her as if she couldn't comprehend or read. Her baby wants to nurse
and he is refusing other forms of diet. His rationale is that the milk
will cause more thick secretions. The mother comes up to me very upset. I
asked her can he breathe when he is nursing? She said yes. I asked her
does he sound worse after he nurses she said no. I said give him the
antibiotics and let him get the one nourishment he loves and needs. And he
needs fluids as much as he will take. I asked her if she had a vaporizer
or cold steamer. She said no. I told her that the warm shower running to
steam up the bathroom may also help his congestion. I need some good
references for composition of breast milk to show this man. If I have
overstepped my bounds I guess I need you to tell me that too.
2. A patient comes into surgery for an exploratory lap r/o appendix. She
also has a baby that is close to six months of age. The anesthesiologist
is aware that she is breastfeeding before she even gets to OR. He tells
her she won't be able to breastfeed for 48 hrs. Just a reference in Dr.
Hale's book doesn't seem to be enough for these guys. I called the
anesthesiologist and told him my understanding that with general
anesthetic for these procedures that if she is awake and alert she can
breastfeed. He compromised and told me 24 hrs. Are there protocols
somewhere to assist these patients?
3. I have a 11 wk infant that has been gaining weight very slowly. The mom
was seen by the peer counselor and referred to me after having her
physician start her on Reglan. She works in a day care. She doesn't always
get time to pump and at times tries to go and feed him the days he is
there. The most milk she is pumping is 4 oz. I had her in my office and
did a pre and post weight. Baby was up only 4 oz from one weeks weight
check. He had nursed 2 hrs prior to coming to me. His weight was up only 2
oz. from that feeding. I have asked her to use a sns with the breastmilk
she is pumping, so that he will obtain more calories per feeding. He is
happy, he has good skin tugor, not fussy at any time. Nurses on demand at
home and on weekends without supplements. I thought he was probably
getting minimum feedings in 24 hrs. 6-7. He is growing in inches and head
circumference. I had her try a whisper wear pump at work so she could be
pumping throughout her day and not have to leave to pump. She said she got
less than when she just goes and pumps 4 oz. in the morning. She will be
in to see me tomorrow and we will evaluate the whisper wear pump whether
or not it is effective. She has great nipples and breasts. Two siblings
she nursed for 4-6 months with no supply issues.
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