I have been working with the mother of a 9 month old baby boy diagnosed one
month ago with Leukemia. He became acutely ill very rapidly and was admitted to
the hospital for chemotherapy. He weighed about 20 lb. at diagnosis. He has
been having weekly rounds of chemo and has stomatitis (mouth ulcers). He now
weighs about 18-3. He had not started soldids before his admission and is
exclusively breastfed. Each week before his chemo he is NPO for 6-7 hr. Hospital
policy requires that he be NPO for only 4 hr. but, of course, as things go in a
large teaching hospital, the procedure is always late.  The medical team,
concerned with his wt. loss, asked for a nutrition consult and the RD recommended
bottle feeding him expressed milk fortified with formula powder for extra
calories. This was totally unacceptable to his mother and she called our lactation
service for a consult. These were her well founded concerns:  Baby won't take
a bottle from her so this would necessitate her leaving her baby every 4 hr.
(he eats every 2.5 hr.) Also he only takes a little from a bottle when she is
not there and waits for her. He refuses solids--his mouth is too sore.
Breastfeeding is his sole source of nutrition and his comfort.

This is the plan I helped her to devise and for now the medical team and
dietician have agreed.  Continue breastfeeding ad lib. (Mom lives in the hosp.
room with the baby). Pump 2-3 times per day after breastfeeding to obtain hind
milk for the Dad to give to the baby when he gives him his one or two bottles
per day. If baby continues to lose wt. start continuous tube feeds of expressed
fortified milk during the night shift. If baby wakes up during this time put
him to breast.

I would appreciate any other ideas or insights that I might share with this
mother re helping baby maintain or gain wt. during these rounds of chemo. I do
know that taking away the breast could result in a baby that won't eat at all a
nd I think that writing this in the baby's chart has scared the team into
letting him breastfeed for now. I am posting with mother's permission.

Kathy Boggs, RN, IBCLC

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