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Date: | Sat, 10 Apr 2010 13:50:32 -0700 |
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Christine:
You give an excellent summary of good practice. FYI: here is a link to the AAP update:
<http://aappolicy.aappublications.org/cgi/reprint/pediatrics;125/2/405.pdf>
I'm hoping that this update is sufficient for our insurance providers and hospital admin to adjust their practices.
Or do we have to go thru the legislature to change the state's medicaid law to specify these parameters as the Standard of Care that must be covered.
Phyllis
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I am not sure what the intent was as I have not read the article.
However, my response would be: "It is NOT normal for a child to be unable to breastfeed
therefore until the child has a diagnosis, he should not be discharged." Then start listing
all the reasons there may be a problem: sepsis, jaundice, delayed lactogenesis II, late preterm,
nipple problems, tongue-ties, short tongues, mandibular asymmetry, retracted chin. etc....
So for example, if the baby can't feed because of a tongue-tie then we need a feeding plan and assessment for
a nipple shield until it can be clipped.
Often the feeding plan will be to do some limited breastfeeding then pump and bottle-feed. Mothers with short nipples and infants with
a short tongue are (in my experience) to be most at risk for bottle preference and I would firmly insist
that the mother be given the choice of how to supplement in this instance. All mothers need a plan that supports infant growth while maintaining or
increasing maternal supply. I would try to obtain a DME request and coverage for an electric pump. She can even request Banked human milk to
supplement with although she will have to pay out of pocket. I have had mothers do this.
These mothers (who need to supplement) must be given very close follow up (1-2 days after discharge and then at least weekly) to ensure
they succeed at breastfeeding. And this should be part of the discharge plan for these dyads.
Since most pediatricians are not skilled in lactation this requires a referral to a lactation consultant.
This is an important policy as babies who are having problems breastfeeding are at high risk of re-hospitalization for jaundice and dehydration
which even further disrupts breastfeeding.
I am most bothered by the underlying message of bottle-feeding is the solution no matter
what the etiology. It is representative of how poorly we have been educated in matters
concerning lactation. I would also remind them that it is the mothers choice on how to supplement
and she should be given the options that are consistent with her child's needs.
Christine Betzold NP CLC MSN
www.theBFclinic.com
714-269-9879
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Phyllis Adamson, BA, IBCLC
Glendale, AZ.
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