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

--
Phyllis Adamson, IBCLC, RLC
Glendale, AZ.
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