Dear all:
I would argue that there is a HUGE difference between adding fortifier to human milk to compensate for some of the minerals and other nutrients a premature infant was unable to get via the umbilical cord and acting as if breastmilk was water.  Even though I have not yet seen a smidgeon of evidence that convinces me that increasing the caloric content of breastmilk by adding a small amount of powder to get to specifically determined small increase, I also see a big difference between a minimal bump up in caloric density and acting as if breastmilk was water.  Yes there are risks to both of those uses of fortifier and powdered milk, but at the very least those are weighed against other risks.  

In the case of adding the same amount of powder to breastmilk as you would to water -- I would say that it is extremely dangerous.  The solute loads would fall outside the realm of safety defined by the FDA.  This is where I would say that it falls into the realm of endangering an infant and we ARE required to report when babies are being put into danger.  If a pediatrician made a miscalculation and increased the dosage of a drug ten-fold because he or she moved a decimal point in the wrong direction, I'm sure the rest of the staff would not be off the hook if they went ahead and gave that dangerous dose knowing that the pediatrician made an error.

Similarly, we ARE required to report child abuse.

Susan Burger, MHS, PhD, IBCLC 

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