Get that cleft palate baby of the abm (use expressed breastmilk if there is
difficulty feeding the baby directly at the breast at present). There was an
article in Pediatrics this year that clearly showed that cleft palate babies
breastfed had less ear infections than bottle fed baby.(Dr. Newman will
probably have the exact reference at his finger tips). Lets also use some
logic here. If the baby is going to get fluid in the Eustacian tube wouldn't
it be better to have physiologic fluid such as BM rather than artificial
junk. As to whether the baby can feed at the breast this will be trial and
error. Dripping ebm into the baby via an SNS while the baby was at the
breast worked for one of my patients (never a drop of formula in that baby
who is now 2 and weighs in the 90th percentile) with one baby with a cleft
of the soft palate.How about another ENT? Sorry if I am ranting but this
lack of knowlege by MDs drives me nuts. I really think this should qualify
for malpractice.


At 09:32 AM 2/15/97 -0500, you wrote:
>Date:     Sat, 15 Feb 1997 09:32:06 -0500
>Reply-To: Lactation Information and Discussion <[log in to unmask]>
>Sender:   Lactation Information and Discussion <[log in to unmask]>
>From:     Automatic digest processor <[log in to unmask]>
>Subject:  LACTNET Digest - 14 Feb 1997 to 15 Feb 1997 - Special issue
>To:       Recipients of LACTNET digests <[log in to unmask]>
>
>There are 13 messages totalling 400 lines in this issue.
>
>Topics in this special issue:
>
>  1. formula advertising
>  2. CLEFT PALATE BABY
>  3. Introduction and question...
>  4. Formula ads direct to physicians (long)
>  5. breast abcess & rash
>  6. Vit K
>  7. leaking
>  8. Jeanette's comments
>  9. hernia
> 10. Liz Baldwin
> 11. intro/formula marketing
> 12. spitting up breastmilk
> 13. flat nipples
>
>
>To post a note  to the 1200 subscribers of  LACTNET, send your note to
>                          [log in to unmask]
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>commands listed below, via e-mail to:
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>http://www.telcomplus.com/~kga/lactation.html
>   LACTNET archives :  http://library.ummed.edu/lsv/archives/lactnet.html
>Date:    Sat, 15 Feb 1997 00:13:41 -0500
>From:    "Lechia Davis (Maternal Instincts)" <[log in to unmask]>
>Subject: formula advertising
>MIME-Version: 1.0
>Content-Type: text/plain; charset=ISO-8859-1
>Content-Transfer-Encoding: 7bit
>
>Aren't these formula companies getting around the guidelines by advertising
>their "expectancy clubs" rather than the formula?  Then, because the mom
>asks for info, that leaves them wide open to send coupons, etc. for their
>products.
>
>Lechia Davis, RNC, ACCE, IBCLC  ([log in to unmask]) (who will blow the
>whole world of marketing breastmilk wide open, when she wins the lottery!)
>Maternal Instincts
>http://www.gamewood.net/~maternal/index.htm
>Date:    Sat, 15 Feb 1997 01:04:09 GMT
>From:    J C Crotteau <[log in to unmask]>
>Subject: CLEFT PALATE BABY
>
>Hi all,
>
>We have a baby born last night with a cleft palate and they are
>questioning pierre-robin syndrome. The cleft involves the entire soft
>palate. An ENT specialist saw the baby and said she cannot breastfeed
>because of the connection between the palate and the eustachian tubes and
>that this baby would get lots of ear infections.  He states it would be
>ok to feed ebm until they to the corrective surgery at 10 months! We are
>now feeding formula with a haberman feeder and she does ok-slow but sure.
>  Is this a case of breastfeeding sacrificed on the alter of ignorance or
>is there any validity to this??  This mom was going to breastfeed but now
>is unsure.
>
>Thanks,
>
>Jane
>Date:    Sat, 15 Feb 1997 04:25:26 -0500
>From:    Pierrette Mimi Poinsett MD <[log in to unmask]>
>Subject: Introduction and question...
>
>Hello all,
>
>I am a board certified pediatrician with a long standing interest in
>lactation and infant nutrition.  My background is rather eclectic.  I did a
>one year predoctoral fellowship in nutrition studying infant feeding plans in
>an Adolescent Mother population (between 2nd and 3rd years of med school
>80-81), a postdoctoral fellowship in Infant Taste and Smell at the Monell
>Chemical Senses Center 1985), worked in community health education (primarily
>Chemical Dependency and AIDS prevention and intervention), did my pediatrics
>training at Cook County Hospital (1983-84) and Kaiser San Francisco
>(1989-92). I also completed a three year commitment with the Public Health
>Service in the National Health Service Corps (1992-1995 /Bakersfield and Las
>Vegas) working extensively with WIC.  In the last year I have been in private
>practice in Modesto CA--also doing a lot of community based work.  I am
>fortunate to work with three nurses with lactation education/counseling
>backgrounds.  I am also now the mother of a three week old infant (
>andlearning that some of my Lactation "advice" was somewhat silly).
>
>I am most interested in LACTNET--there aren't other pediatricians in town
>with an interest in lactation issues.  I am also interested in info in
>creating baby friendly workplaces  and health care facilities (not just the
>hospital but offices, clinics etc).
>
>My question is:
>
>Are there alternative positioning techiniques for mothers with Carpal Tunnel
>Syndrome?  For that matter positioning for moms with physical challenges in
>general.  I could not find much in the Orthopedic Literature.  Perhaps
>someone with an OT or PT background could enlighten me on this.
>
>Looking forward to the dialogue:
>
>Pierrette Mimi Poinsett MD FAAP
>(Mimi is easiest)
>Modesto CA
>Date:    Sat, 15 Feb 1997 07:01:37 -0600
>From:    Kathy Dettwyler <[log in to unmask]>
>Subject: Formula ads direct to physicians (long)
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>Mead Johnson makes a beautiful, full-color, glossy, thick brochure for
>doctors.  It is called "Your resource for mother satisfaction."  Not "your
>resource for child health" notice....
>
>Inside:
>
>"The Enfamil family provides more infant formulas to meet more nutritional
>needs; four infant formulas--Enfamil, Lactofree, ProSobee, Nutramigen--to
>meet a range of tolerance needs: milk-based feeding, common feeding problems
>when due to lactose sensitivity, family history of allergy/milk sensitivity,
>colic due to milk protein allergy."
>
>"Continued good nutrition with Next Step and Next Step Soy Toddler Formulas.
>The Enfamily Family of Formulas Guide is organized so you can educate
>parents in the logic of formula selection.  Helping pediatricians keep
>infants happy and their parents satisfied for nearly 90 years."
>
>Again, no mention of health, no mention of the logic of choosing formula
>over breastfeeding to begin with.
>
>Then there's a chart labeled "The Enfamily Family of Formulas*" where the
>asterik directs you to tiny tiny print under the chart that reads: "If
>breastfeeding is not chosen or a supplement is needed."
>
>First page shows mother holding sleeping 4-month-old (?) baby with thumb in
>its mouth and the caption reads "Now that we've got Jenny on the right
>formula, we're all sleeping through."
>
>Implying that the right formula can make a baby sleep through the night at a
>very young age.  No mention that night waking is NORMAL for a baby this age
>and may reduce the risk of Sudden Infant Death Syndrome.
>
>Next page shows mom kissing baby and the caption reads: "I've got a million
>concerns.  Julie's formula isn't one of them."
>
>IT OUGHTTA BE!
>
>The info opposite this picture says "Multiple formulation improvements; most
>recently, the development of a fat blend closer to that of breast milk than
>our previous formulation....Extensive educational materials to uniquely
>support mothers' needs for information....because you want every mother in
>your practice to be satisfied."
>
>
>Next page is for Lactofree, and shows mom holding one-year-old and says
>"Feeding time is no longer fussy time for Ethan."  The copy mentions "The
>lactose-free formula that resolves common feeding problems when due to
>lactose sensitivity, for happy babies and satisfied moms."  Again, no
>mention at all of HEALTH.
>
>Next shows a dad and baby and the caption reads: "With our family history of
>allergies, Amy's doctor said to start her on a soy formula."  Sounds like
>Amy needs a NEW DOCTOR!!  The copy on the facing page says: "When a father
>is sensitive to his family's allergies, your ProSobee recommendation can
>help him feel satisfied instead."
>
>Next page ad for Nutramigen shows mom holding tiny, dehydrated (?), anemic
>(?), but cute baby, and the caption reads: "In two days, Sara's colic (due
>to milk protein allergy) went away.  And so did my worries."
>
>Next page ad for Next Step Toddler Formula shows mom and toddler and caption
>reads: "Now I know Jamie is getting the iron she needs."  Mentions in the
>copy on the facing page that is has six times as much of a bunch of
>nutrients as cow's milk, and that three 8 oz. servings provide over 90% of
>the RDA for iron for children ages 1 to 3 years, and over 50% of the RDA of
>12 essential vitamins and minerals for toddlers aged 1 to 3 years."  [Hey,
>let's hear it for not giving cow's milk til age three.  I LIKE IT.
>Obviously if your child is breastfeeding instead of formula-feeding, then
>they should continue breastfeeding until 3 years!]  Ends with "Satisfied the
>demands of toddler nutrition as it satisfies mothers."  Again, no mention of
>HEALTH!
>
>Next page ad for Next Step Soy Toddler Formula shows Asian mom and daughter
>and caption reads: "Joy's ready to switch from infant formula.  Where do we
>go from here?"  Mentions that it is good tasting.  Wanna bet?
>
>Next page ad for a variety of specialty formulas for children with inborn
>errors of metabolism (PKU, Maple Syrup Urine Disease, etc.), shows dad and
>baby and caption reads: "I'm so grateful there's a company that would make a
>formula just for Emma."  No mention AT ALL on this page of "If breastfeding
>is not CHOSEN....", just the implication that these babies can't be
>breastfed at all.  And of course, the dad wouldn't be grateful that there's
>a WOMAN who would make a formula just for Emma -- her mother!
>
>Last page is an ad for Infalyte, their rehydration solution; shows mom and
>child and caption reads: "Now when Joey gets diarrhea, I don't worry that
>he'll get dehydrated."  Ad copy recommends alternating infalyte with breast
>milk or one of their formulas.
>
>Appalling, no?  And we think advertising just to doctors will be a step
>forward??
>
>Katherine A. Dettwyler, Ph.D.
>Texas A&M University
>Date:    Sat, 15 Feb 1997 07:50:38 -0600
>From:    Evelyn Landry <[log in to unmask]>
>Subject: breast abcess & rash
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>I am asking for any suggestions for helping a mom who has a abscess - this mom
>1st had 1 sore nipple - did all the things suggested and it seemed to
>improve.  Next mastitis - She used heat, massage, hot showers, nursed often,
>pumped  - Dr. put her on antibiotics seemed to clear up.   She called back
>to say she developed another area on her breast - Dr. did a needle biopsy
>withdrew "pus" put her on a different antibiotic, told her to come back in 3
>days to determine if it was necessary to open and drain the area.  This mom
>is on the verge of giving up BF but really doesn't want to.  She did tell me
>that with her previous baby she was also getting frequent bouts of mastitis.
>I asked if the Dr. had cultured the specimen to determine the most effective
>antibiotic - he didn't.  We discussed the possibility that the 1st med
>possibly didn't clear up the mastitis and this was actually still dealing
>with the original problem.  She only took the meds for 8 days.  We went over
>all the things in BF Question & Ans
>book - nothing seems to be missing in how this mom is BF.  We discussed
>taking the med for 10-14 days, then staying on a low dose for 2-3 months,
>checking the baby, even possible yeast.  Any other suggestions?
>
>Another situation - has anyone ever heard of a rash on the baby's face being
>caused by the "mother's" hormones while breastfeeding????  A Ped Dr. told a
>mother this, and then put the baby on a topical cream to clear it up.  Baby
>is 1 month old, doing great with BF. Sounded like a contact rash to me,
>started on the cheeks, next rest of the face and neck.  Any ideas?  Thanks.
>P.S.  Really appreciated the fast responses I got regarding my questions
>about papilloma.  The mom was thrilled, and ready to get a 2nd opinion and
>plans to BF.
>Date:    Sat, 15 Feb 1997 14:05:58 +0000
>From:    Patricia Young <[log in to unmask]>
>Subject: Vit K
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>Isn't Vit K given IM at birth to provide baby with a supply until baby's
>body starts to naturally make enough of own Vit K in the gut, around day 8
>(when Jewish babies are traditionally circumcized)?  Our current use of Vit
>K is based on the knowledge that a newborn has low levels until Vit K is
>made by baby's gut- flora in gut develop after feeding and make K.  So what
>if baby's Vit K level at 2-3 mo is 1/2 of adults, maybe that's the design
>plan.  As a Pediatric nurse practitioner I don't want to have to give "one
>more shot" to a baby just because he's bestfed! Pat in rainy southern NJ
>Date:    Sat, 15 Feb 1997 14:06:00 +0000
>From:    Patricia Young <[log in to unmask]>
>Subject: leaking
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>Chandice Covington, PhD, RN, CPNP at Wayne State Univ. Detroit MI is doing
>research on breast fluids post weaning and their relationship to Ca.  I
>believe the premise is that the fluids contain carotinoids and are
>protective.  They have been collecting and testing fluids from women's
>breasts.  I might be wrong, but I think post menopausal women had less
>sucess at getting fluids than premenopausal women.  I'll try and get an
>update from her.  Maybe something has been published.  Pat Young in SNJ, a
>WSU grad!
>Date:    Sat, 15 Feb 1997 14:06:04 +0000
>From:    Patricia Young <[log in to unmask]>
>Subject: Jeanette's comments
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>Jeanette's comments on advice given by two drs is sad commentary, but all
>too frequently what most of us hear.
>
>I use a logarithm that follows Total and direct bilirubin and what to look
>for when levels are greater than or lower than.  If I see a bestfed baby at
>2-3 weeks who is "still" yellow and growing nicely, I do one bili to assure
>that we are probably not dealing with anything exotic like biliary
>obstruction etc. Then I just watch the yellow baby thrive on mom's milk!
>
>Sorry I don't know orig source of logarithm.  The only details on it are
>page 236, Chapter 16: Neonatal Hyperbilirubinemia.  I think it was a ped text.
>
>Many HCPs think that BF babies have infrequent BMs.  This is a widely held
>notion.  The problem is that it is BF babies over 6 wks of age who tend to
>stool less frequently.  In all my years of seeing moms and babies I've only
>seen 2 who truly stooled infrequently right from the beginning.  I agree
>with the experts who think that stooling in the first days is a better
>indicator of intake than wet diapers.  I find this begins to change around
>7-8 days, to more wet, less stool.  But a good gaining bestfed baby stools a
>lot in the first few weeks.  Anyone else agree?  Wish we could do a good
>survey and publish what the true norm is for a BF baby!
>
>Do you know, according to Rogers it takes about 20 years for any new info to
>filter into use?  Don't get discouraged.  Pat Young in SNJ
>Date:    Sat, 15 Feb 1997 14:06:01 +0000
>From:    Patricia Young <[log in to unmask]>
>Subject: hernia
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>Stephanie- why wait until baby is 6 mo.  Why not do it sooner when baby is
>less active and easier to care for? and lighter!  Pat Young in SNJ
>Date:    Sat, 15 Feb 1997 14:06:06 +0000
>From:    Patricia Young <[log in to unmask]>
>Subject: Liz Baldwin
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>I have her current # if you want to contact me privately.  She was a big
>help to my neice.  She tells it like it is, pulls no punches, and is usually
>right.
>Pat Young in SNJ
>Date:    Sat, 15 Feb 1997 09:15:38 -0500
>From:    Robin/Joan MacNeil <[log in to unmask]>
>Subject: intro/formula marketing
>MIME-Version: 1.0
>Content-Type: text/plain; charset="us-ascii"
>
>Hello everyone on Lactnet!
>
>This is my first post, tho I've been lurking for a while. The dynamics of
>this net are facinating! My name is Joan, wife of Robin, mother of
>exclusively breastfed Kyla (7 1/2), Connor (4 3/4) and twins - names yet
>unknown - due 15 May 98. I am an RN (BScN) who works full time as a Clinical
>Resourse Nurse in Labour and Delivery at a tertiary care Maternity hospital
>in Nova Scotia (Canada) that records about 5500 deliveries a year. (Believe
>it or not we actually work on a Family Centered Care model and provide
>one-to-one nursing for families in active labour!) Currently, as a side
>line, I'm involved in data analysis of a survey type study about the post
>birth needs of families, which brings me to the point of my post. I've been
>noticing the thread about formula marketing, and have noticed that an awful
>lot of the mums in the study have switched their baby from the S-----c that
>my hospital (about 25% of our moms leave hospital formula feeding) uses to
>C-------- 'Best' S---t - usually at their physicians recommendation! Guess
>the marketing is working, eh! Too bad so few of them realize that the only
>'best start' or even good start is breast milk!!!!!!!
>
>Back to lurking!
>Joan MacNeil ([log in to unmask])
>Date:    Sat, 15 Feb 1997 09:30:49 -0500
>From:    "Deborah L. Tobin, RN, BSN. IBCLC" <[log in to unmask]>
>Subject: Re: spitting up breastmilk
>
>In a message you wrote:
><<Date:    Wed, 12 Feb 1997 22:44:54 EST
>From:    "Ann M. Calandro" <[log in to unmask]>
>Subject: Spitting up breastmilk
>I need suggestions for a 4 day old baby , spit up a lot,....mom describes in
>a projectile way.  He began showing signs of dehydration yesterday, >>
>
>Ann,
>Due to peds background, whenever I see a first born male baby with increasing
>bouts of spitting up progressing to projectile vomiting to the point of not
>gaining weight, I see pyloric stenosis written on the red flag ( does have a
>familial streak). Otherwise, the suggestions you've gotten about deleting
>dairy may work. I usually try one other stategy first tho before deleting
>dairy, and that is decreasing foremilk and increasing hindmilk intake. I
>believe you said in a later post that the mom did not seem to have an
>over-production. Still, may want to try adjusting baby's intake by increasing
>time on first breast with good massage to that breast towards end of feeding
>to more fully empty ducts of hindmilk. I have resorted to pumping off
>foremilk ac. Recently had a case like yours, ped doc said not pyloric
>stenosis, (doc would have been looking for stomach distention with left to
>right peristaltic waves and palpable olive-shaped mass in the right upper
>quadrant), so we did as above with drastic improvement x10days. Projectile
>vomiting renewed, mom went to another doc, radiology study was quick to show
>pyloric stenosis. Not sure why there was that 10 day improvement, possibly
>the thicker hindmilk stayed down better (as might the thicker consistency of
>formula in your case).
>
>Deborah Tobin
>Springfield, VA
>Date:    Sat, 15 Feb 1997 09:31:03 -0500
>From:    "Deborah L. Tobin, RN, BSN. IBCLC" <[log in to unmask]>
>Subject: Re: flat nipples
>
>In a message you wrote:
><<Date:    Fri, 14 Feb 1997 13:49:42 -0600
>From:    "Patricia Gima, IBCLC" <[log in to unmask]>
>Subject: pendulous breasts/flat nipples
>>>
>Have you tried "inverted nipple hold" (Marmet and Shell): gently grasping the
>areolar tissue at its margin to shape the breast into a wedge that is held as
>rooting is elicited, gives holder more control to place the nipple deep in
>the baby's mouth at latch. This works better when that soft nipple you
>describe is erected (as you mentioned: pumping and nipple stim) just prior to
>latch, and breast is elevated with small roll underneath and secured in place
>while baby feeding.
>
>Deborah Tobin
>