Suzanne asks: "I appreciate all of y'all on LACTNET and everything you've  
taught me, and
how much us peds still need to learn!  But this  "hypothetical" situation may
not be as rare as you think.  I truly would  appreciate positive, specific
suggestions.  (Send PM, no flames" 
 
I would get some formula to that baby ASAP and then I would get the family  
involved with the proper social service agency that would immediately address  
this family's need to provide sufficient and adequate nutrition for the  baby. 
 I can't believe anyone on Lactnet would do any differently. If free  samples 
are unethical then you could purchase some formula for your practice.  What 
other choice is there--let the baby starve or suffer the consequences of  
really inadequate nutrition? We have no other options in the US--no affordable  
source of breastmilk from a milk bank and no insurance coverage for  it.  I have 
had newborns return to the outpatient lactation  clinic with a greater than 
10% wt. loss, decreased stamina and  mom with very low supply. The first thing I 
do is FEED THE BABY, the only option  available being formula. I then address 
the breastfeeding problem and give the  family a plan to address the 
breastfeeding issues and low milk supply. And, by  the way, this also is not at all a 
rare situation. I think the Texas law is  good but we do need to look at 
ramifications. The intent is certainly not to  withhold nutrition from a baby--the 
intent is to eliminate the widespread,  unethical practice of throwing formula 
at every new family. This truly  undermines breastfeeding and is the practice 
that should be addressed.  How  could a pediatrician be held accountable for 
feeding a malnourished infant? As  lactation consultants we have to be 
reasonable or we lose all credibility. And,  of course, we don't want to admit the 
baby to the hospital if all he needs is  some food.
 
Kathy Boggs, RN, IBCLC

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